Qualifying Life Events

 

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.

Right now, for some qualifying life events — needing coverage because of COVID-19, losing your previous coverage, and a new marriage or domestic partnership — your coverage will start on the first day of the following month. For most other qualifying life events, the start date for coverage depends on the date of plan selection.

Lost job or income
  • You recently lost employment, were laid off, or left your job.
  • Loss of income due to fewer hours or less work.
Lost or will soon lose my health insurance
  • You lose Medi-Cal coverage.
  • You lose your employer-sponsored coverage.
  • Your COBRA coverage is exhausted. 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.
Newly qualifies for app-based driver 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.
Affected by wildfires
  • Exceptional circumstances occurred on or around plan selection deadlines, including natural or human-caused disasters (for example wildfires) and medical emergencies.
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.
  • 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 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.
None of the above (Continue to review my application for Medi-Cal/Medi-Cal Access Program)

If none of these qualifying life events apply, you should still apply using "None of the above," because you may be eligible for Medi-Cal or the Medi-Cal Access Program (MCAP) for pregnant women based on your income. Regardless of which life event you select, your application will still be reviewed for coverage through Medi-Cal and MCAP.


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