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The Impact of Life Changes on Your Healthcare Coverage

image of couple who forgot about their healthcare coverage during a qualifying life event

If you are new to the health insurance marketplace, you should know that healthcare coverage changes following significant life events. For instance, you may have experienced the birth of a child, marriage, or relocation. These events may alter your benefits and access to special enrollment periods. 

Since these life transitions may be drastic, it’s necessary to learn how they impact your coverage. To alleviate your stress, our insurance specialists at My Healthcare Direct have provided a detailed guide to direct you on how life events affect your coverage.

How Does the Healthcare Marketplace Define Life Changes?

Qualifying Life Events

The healthcare marketplace refers to life events as qualifying life events (QLE), defined as changes to your situation. Although these events may or may not be anticipated, they may alter your eligibility status. 

The marketplace has several types of qualifying life events, which include the following:

  • Loss of health coverage:
    • Losing job-based or individual coverage
    • Losing student-based coverage
    • Turning 26 years old
    • Eligibility for
      • Medicaid
      • Medicare
      • Children’s Health Insurance Program (CHIP) 
  • Residence changes:
    • Certain household moves
      • Seasonal jobs
      • Student relocation
      • Transitional housing
      • Moving to a different zipcode or county
  • Household:
    • New baby
    • Marriage
    • Adoption
    • Divorce
    • Death
  • Other QLEs:
    • A raise or drop in income
    • Gaining membership in a federally recognized tribe
    • Gaining status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
    • Leaving incarceration (jail or prison)
    • AmeriCorps membership changes
    • Changes in income
    • Becoming a US Citizen

If you are uncertain what factors influence your coverage, speak to your provider. 

  • Complex issues: Several complicated or exceptional circumstances may qualify you for special enrollment. For example, if misinformation from an agent or broker kept you from enrolling during the plan’s open enrollment period. Another would be if a natural disaster prevented you from enrolling during the open enrollment period.
image of mother holding newborn who needs to re-evaluate her healthcare coverage after her qualifying life event
A child being born is a qualifying life event. Image of mom holding her newborn daughter.

How Major Life Events Affect Your Healthcare

Along with gaining access to the Special Enrollment Period, QLEs may result in adjustments to your healthcare plan. For instance, a marriage, childbirth, loss, or gaining a dependent may significantly change your benefits. With childbirth, you may receive additional coverage options for your child. 

In addition, your copays and deductibles may also differ after a life event. 

Because benefits vary based on your provider, it’s important to contact them with any questions. They can provide detailed information regarding your current versus new list of benefits.

Life Events Change Your Needs and Health Choices

According to the Department of Labor, challenges often make you reconsider your health choices. In effect, your healthcare needs will adapt based on your circumstances. 

For those experiencing a divorce, you may experience a loss of income. If your spouse paid for private insurance, you may be in a tough position. Consequently, you may no longer be able to afford your deductibles or premiums. So, if you battle a health condition or an injury to compound the loss of funds, this may require you to switch to a policy that covers home care or rehabilitation.

Similarly, gaining a dependent may complicate matters if they need skilled nursing care. In that situation, you might consider placing them in a nursing home or finding a policy that offers home health services (in-home nursing for homebound members).

But suppose you are their caregiver for a dependent. In that case, you may need to find a plan that provides respite care (short-term relief for primary caregivers) for a much-needed reprieve from the demands and responsibilities.

Reporting QLEs to Your Provider

The healthcare marketplace recommends reporting changes immediately since they may affect your coverage or savings. More so, new plans may be available to you right away. For example, you could qualify for more savings if your income decreases.

If you fail to report the difference, you may be asked to pay back some or all of your premium. The sooner you make the revisions, the less you will owe at tax time.

After modifying your provider, you may be asked to submit documents. To notify them, you must update your application by logging into your healthcare.gov, making edits, and selecting “reporting a life change.” After submitting, you will receive your results. 

If you can’t make these updates online, you can do so via phone or in-person help, like someone in your community knowledgeable on the subject.

What to Expect After Reporting 

Following the report, you can expect a new Marketplace Eligibility Notice. This notice will inform members about their eligibility regarding the following:

  • Marketplace health plans
  • Advance payments of the premium tax credit (APTC) 
  • Cost-sharing reductions (CSRs)
  • Special Enrollment Periods (SEPs) indicated by a deadline to enroll in a Marketplace plan
  • Medicaid and the Children’s Health Insurance Program (CHIP)
  • If you have a data matching issue (DMI) or SEP verification issue (SVI) 
  • Coverage start dates
  • Information about your right to appeal 

You will also get an Eligibility Notice anytime the Marketplace re-processes your application during the year (i.e., after a DMI expires) or during annual redeterminations or re-enrollment for the following coverage year.

To learn more about the elements listed on the eligibility notice, speak to your provider or consult our independent insurance experts at My Healthcare Direct. We are highly knowledgeable and experienced in the healthcare marketplace.

Contact My Healthcare Direct for Assistance Navigating the Health Insurance Marketplace

Understanding how QLEs impact your healthcare coverage is necessary for managing your care needs. If you need help navigating the healthcare marketplace, rely on our specialists at My Healthcare Direct

Our 100% independent agency does not operate based on self-interests, hold you captive, or offer you proprietary products. Instead, we provide in-depth knowledge of multiple insurance products, companies, and guidelines. At My Healthcare Direct, we are dedicated to serving our clients proactively throughout various situations and obstacles that may arise.

Please contact us today to speak with one of our representatives!

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