Can You Change Health Insurance at Any Time?
Learn the specific periods and life events that allow you to change your health insurance. Understand how to update your coverage effectively.
Health insurance coverage in the United States is generally not something that can be changed at any time an individual chooses. Instead, modifications or new enrollments are typically restricted to specific periods each year or are permitted only when certain life events occur. Understanding these designated windows is important for ensuring continuous and appropriate health coverage.
Understanding Open Enrollment
Open Enrollment is the designated annual period during which individuals can enroll in a new health insurance plan, change their existing coverage, or re-enroll for the upcoming year. For plans offered through the Affordable Care Act (ACA) Marketplace, this period typically runs from November 1 to January 15 in most states, with coverage often beginning on January 1 if enrolled by mid-December.
Employer-sponsored health plans also have their own Open Enrollment periods, which are set by the employer and usually occur in the fall, allowing benefits to start at the beginning of the calendar year. During this time, individuals can review offerings, select different coverage levels, or choose between plan types like Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). Missing this annual window generally means waiting until the next Open Enrollment period to make changes, unless a qualifying life event occurs.
Special Enrollment Period Triggers
A Special Enrollment Period (SEP) allows individuals to enroll in or change health insurance plans outside the standard Open Enrollment period. This opportunity arises when a qualifying life event (QLE) significantly impacts an individual’s household or access to health coverage. Individuals typically have a 60-day window, either before or after the event, to act on an SEP.
One common trigger for an SEP is the loss of existing health coverage. This can include losing job-based insurance, the end of COBRA coverage, turning age 26 and no longer being covered by a parent’s plan, or losing eligibility for government programs like Medicaid or the Children’s Health Insurance Program (CHIP). A change in household size also frequently qualifies for an SEP. This category encompasses events such as getting married, experiencing a divorce or legal separation that results in loss of coverage, or the birth, adoption, or placement of a child.
Changes in residence can also trigger an SEP, particularly if moving to a new area where different health plan options are available, or moving from a shelter or other transitional housing. Other qualifying events include gaining or becoming a dependent due to a court order, changes in income that affect eligibility for subsidies, gaining U.S. citizenship or lawful presence, or release from incarceration. Providing documentation to verify the qualifying event, such as a marriage certificate, birth certificate, or a letter from a former employer confirming loss of coverage, is often a requirement to utilize an SEP.
Process for Changing Your Plan
Once an individual determines they are eligible to change their health insurance plan, either through Open Enrollment or a Special Enrollment Period, the process involves specific steps. For those seeking coverage through the ACA Marketplace, the primary action is to access the HealthCare.gov website or their state’s equivalent exchange. This platform allows users to log into their existing account, update their personal and household information, and then compare available plans. After reviewing the options, which may include different metal levels like Bronze, Silver, or Gold plans, the individual can select a new plan and complete the enrollment application.
For individuals covered by an employer-sponsored health plan, changing coverage typically involves contacting the human resources department or benefits administrator. They can provide information on the company’s specific Open Enrollment procedures or guide employees through the steps required for a change due to a qualifying life event. This might involve completing specific forms provided by the employer or the insurance carrier. It is important to adhere to any internal deadlines set by the employer to ensure the desired changes are processed.
After submitting the application or required forms, individuals should anticipate receiving confirmation of their new coverage. This confirmation often includes details about the effective date of the new plan and when new insurance identification cards will be issued. It is generally necessary to pay the first premium directly to the insurance company for the new coverage to become active. Maintaining communication with the Marketplace or employer’s benefits team can help ensure a smooth transition to the new health insurance plan.