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It's "Locked-In" Season for individual Health Insurance.

Here are the special exceptions that may allow someone to enroll mid-year or make a plan change



Qualifying Life Events

 

This list is applicable only to Individual & Family Plans ("IFP") in California offered directly through insurance companies such as Blue Shield, Anthem Blue Cross, Health Net, or Kaiser, or through Covered California, to self-employed individuals and families under age 65 who must purchase insurance on their own, or individuals and families under age 65 who work for an employer who does not offer group Employee Benefits. Medi-Cal (Medicaid) enrollment is year-round for low-income individuals & families. Small Business groups can start coverage anytime. Medicare has its own separate deadlines and Qualifying Life Events.



A change in income, or your income is less than 150 percent of the federal poverty level
  • You are already enrolled in a Covered California plan, but your income has changed and you became newly eligible or ineligible for tax credits or cost-sharing reductions. 

  • For 2024, your expected income is less than $21,870 as a single person, less than $29,580 for a household of two people, less than $37,290 for a household of three people, or less than $45,000 for a household of four people. (For other household sizes, see the Federal Poverty Level Chart under the 150 percent column.


Paid the penalty for not having health insurance
  • Paid the Individual Shared Responsibility Penalty to California’s Franchise Tax Board because you didn’t have health insurance in the previous tax year.

Lost or will soon lose my health insurance
  • You lose Medi-Cal coverage.

  • You lose your employer-sponsored coverage.

  • Your COBRA coverage ends, or you stop receiving government subsidies or employer contributions for your COBRA coverage. Note: Not paying your COBRA premium is not considered loss of coverage.

  • You are no longer eligible for student health coverage.

  • You turn 26 years old and are no longer eligible for a parent’s plan.

  • You turn 19 years old and are no longer eligible for a child-only plan.

Affected by wildfires or other publicly declared state of emergency
  • Experienced a natural or human-caused disaster (for example wildfires) that resulted in the declaration of a state of emergency in California.

Newly qualifies for health insurance stipend
  • New driver for a ride sharing or delivery company as an independent contractor.

  • Existing driver of a ride sharing or delivery company who expects to drive enough hours to receive the health care stipend.

Got married or entered into domestic partnership
  • One or both members of the new couple can use the special enrollment period to enroll in coverage.

Had a baby, adopted a child, or began fostering a child
  • The entire family can use the special enrollment period to enroll in coverage.

  • If you receive a child in foster care, you will need to indicate “adopted a child” in the drop-down menu when you apply.

Permanently moved to or within California
  • You move to California from out of state.

  • You move within California and gain access to at least one new Covered California health insurance plan.

Gained citizenship/lawful presence
Returned from active-duty military service
  • You have lost coverage after leaving active duty, reserve duty, or the California National Guard.

Domestic abuse or spousal abandonment
Federally recognized American Indian/Alaska Native
  • If you are a member of a federally recognized American Indian tribe, you can enroll at any time and change plans once per month.

Released from jail or prison
 
Other qualifying life event
  • You are already enrolled in a Covered California plan and become newly eligible or ineligible for tax credits or cost-sharing reductions. 

  • You are already enrolled in a Covered California plan and you lose a dependent or lose your status as a dependent due to divorce, legal separation, dissolution of domestic partnership, or death.

  • You recently gained access to an individual coverage HRA (ICHRA) or you were newly provided a qualified small employer health reimbursement arrangement (QSEHRA).

  • Misconduct or misinformation occurred during your enrollment, including:

  • An agent, certified enroller, Service Center representative or other authorized representative enrolled you in a plan that you did not want to enroll in, failed to enroll you in any plan or failed to calculate premium assistance for which you were eligible. 

  • Misrepresentation or erroneous enrollment, including:

  • Incorrect eligibility determination. This includes if you applied during open enrollment and were initially told you were eligible for Medi-Cal and then later determined not to be eligible for Medi-Cal.

  • The health plan did not receive your information due to technical issues.

  • An error in processing your verification documents resulted in an incorrect eligibility result.

  • Incorrect plan data were displayed when you selected a plan: Data errors on premiums, benefits or copay/deductibles were displayed; incorrect plans were displayed; or a family could not enroll together in a single plan.

  • Your health plan violated its contract.

  • You did not receive timely notice (and were otherwise reasonably unaware) of an event that may have qualified you for a special-enrollment period.

  • You received a certificate of exemption for hardship from Health and Human Services for a month or months during the coverage year but lost eligibility for the hardship exemption outside of an open enrollment period.

  • You are required by court order to provide health insurance for a child who was been determined ineligible for Medi-Cal and CHIP, even if you are not the party who expects to claim the child as a tax dependent.

  • You are enrolled in “share of cost” Medi-Cal, and have met your share of cost in one of the past two months. You may choose to keep your enrollment in share-of-cost Medi-Cal when you enroll in a Covered California plan. You can use this qualifying life event for a special-enrollment period only once in a calendar year.

  • You are a member of AmeriCorps/VISTA/National Civilian Community Corps: 

  • If you entered AmeriCorps or one of the other organizations listed above outside of open enrollment.

  • If you ended your service with one of the organizations listed above.

  • You have a non-calendar year health plan (including “grandfathered” and “non-grandfathered” health insurance plan) outside of Covered California that has expired or will soon expire, and you would like to switch to a Covered California health insurance plan instead of renewing your current plan.

  • Your provider left the health plan network while you were receiving care for one of the following conditions:

  • Pregnancy

  • Terminal illness

  • An acute condition

  • A serious chronic condition

  • The care of a newborn child between birth and age 36 months

  • A surgery or other procedure that will occur within 180 days of the termination or start date.

60 DAYS TO REPORT A CHANGE: If you experience a qualifying life event, you can enroll in a Covered California health insurance plan outside of the normal open-enrollment period. Most special-enrollment periods last 60 days from the date of the qualifying life event.

For most qualifying life events, your coverage will start on the first day of the following month after you select a plan.


This list is current as of April 2024. Check for updates at: https://www.coveredca.com/support/before-you-buy/qualifying-life-events/

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