Can I Change Marketplace Plans?

The Health Insurance Marketplace provides a platform for individuals, families, and small businesses to shop for and enroll in health coverage. This system allows consumers to compare health plans based on various factors, including price, benefits, and provider networks. While you can change Marketplace plans, this is generally permitted only under specific circumstances. This article guides you through these situations and the necessary steps to change your plan.

When You Can Change Plans

Changing your health insurance plan through the Marketplace is typically restricted to specific enrollment periods. The primary opportunity for most individuals to switch plans is during the annual Open Enrollment Period (OEP). For the federal HealthCare.gov Marketplace, this period usually runs from November 1 to January 15. To ensure coverage begins on January 1, individuals typically need to select a plan by December 15.

Outside of OEP, you can only change your Marketplace plan if you qualify for a Special Enrollment Period (SEP). An SEP is a specific window of time triggered by certain qualifying life events (QLEs). These events signify significant changes in your life that impact your health coverage needs or eligibility.

Common QLEs include:
Changes in your household, such as getting married, divorced, having a baby, or adopting a child.
Changes in your health coverage status, like losing job-based health insurance, losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP), or turning 26 and losing coverage under a parent’s plan.
Moving to a new area that offers different health plan options.
Changes in income that affect your eligibility for premium tax credits or cost-sharing reductions.

Most SEPs provide a 60-day window around the qualifying event to enroll in a new plan, though some events may have slightly different timeframes.

Preparing to Change Your Plan

Before initiating the process of changing your health plan on the Marketplace, gathering essential financial and healthcare-related information is important. Your eligibility for financial assistance, such as premium tax credits and cost-sharing reductions, depends on your estimated household income for the upcoming coverage year and your household size. It is necessary to accurately project your Modified Adjusted Gross Income (MAGI), considering any expected changes in income or household composition throughout the year.

Assessing your current and anticipated healthcare needs is another important preparatory step. Compile a list of all prescription medications you and your household members take, including dosages. Additionally, list your preferred doctors, specialists, and hospitals, as you will need to verify if they are included in the network of any potential new plans. This evaluation helps ensure that a new plan will adequately cover your specific medical requirements and maintain continuity of care.

Understanding Key Health Insurance Terms

Understanding key health insurance terms is also beneficial for comparing plans effectively. Familiarity with these terms allows for a more informed comparison of different plan structures, such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), and Point of Service (POS) plans, which vary in network restrictions and referral requirements.

Premium: The fixed amount you pay monthly to maintain your coverage.
Deductible: The amount you pay for covered services before your insurance begins to pay, excluding preventive care.
Copayments: Fixed amounts paid for specific services, like doctor visits.
Coinsurance: A percentage of the cost you pay for services after meeting your deductible.
Out-of-pocket maximum: The most you will pay for covered services in a year, combining deductibles, copayments, and coinsurance, but not including premiums.

Changing Your Plan Step-by-Step

Once you have gathered all necessary information and determined your needs, the next step involves navigating the Marketplace website to implement your plan change. You will begin by logging into your existing HealthCare.gov account. This account holds your current application and personal details, which you will need to update.

After logging in, locate the section that allows you to report changes or view new plans. It is crucial to update your application with any recent changes in your household income, household size, or address, as this information directly impacts your eligibility for financial assistance and the plans available to you. The Marketplace platform provides tools to compare available plans by inputting your specific healthcare needs and financial details, allowing you to filter and review options that align with your requirements.

When selecting a new plan, carefully review its details, including the premium, deductible, copayments, and coinsurance, as well as checking if your preferred doctors and hospitals are in the plan’s network. After making your final selection, proceed to review your application for accuracy before submitting the plan change. Following submission, you will receive a confirmation, and your new coverage generally becomes effective on the first day of the month after you enroll, provided you enroll by the 15th of the preceding month. Your enrollment is not complete until you pay your first month’s premium directly to the insurance company, not the Marketplace. The insurance company will then send you new plan documents and an ID card, confirming your active coverage.