Can You Change Health Insurance Plans Mid-Year?

Health insurance policies typically operate on an annual cycle, with individuals selecting or modifying their plans during a designated Open Enrollment Period each fall. However, certain life events can create exceptions to this rule, enabling individuals to make changes to their health insurance outside of the standard Open Enrollment Period, known as a Special Enrollment Period.

Understanding Special Enrollment Periods

A Special Enrollment Period (SEP) provides a limited timeframe outside the annual Open Enrollment Period. SEPs are triggered by specific life changes, which generally fall into several categories, reflecting changes in household, residence, or existing health coverage.

Changes in household frequently qualify individuals for an SEP. Examples include getting married, or experiencing a divorce or legal separation that results in a loss of health coverage. The birth of a child, adoption, or placement of a child for foster care also trigger an SEP, allowing new family members to be added. A death in the family that impacts existing coverage can also qualify.

Moving to a new permanent residence often initiates an SEP, particularly if the move takes an individual to a new service area where their current plan is unavailable. This includes moves to a new ZIP code or county, or even moving to the U.S. from a foreign country.

Loss of other health coverage is another common trigger for an SEP. This can occur due to losing job-based insurance or aging off a parent’s health plan. Losing eligibility for government programs like Medicaid or the Children’s Health Insurance Program (CHIP) also qualifies for an SEP. Other qualifying events include gaining a dependent due to a court order or changes in income affecting Marketplace subsidy eligibility.

Required Information and Documentation for a Mid-Year Change

Initiating a mid-year health insurance change during a Special Enrollment Period requires providing specific information and documentation to verify eligibility. The types of documents needed will vary based on the specific event that triggered the SEP.

For changes related to household events, legal or government-issued documents are typically required. A marriage certificate confirms a marriage, while a birth certificate or adoption record verifies the addition of a child. In cases of divorce or legal separation, a divorce decree or court order showing loss of coverage is necessary.

If the SEP is due to a change in residence, documentation proving the new address and the date of the move is needed. Acceptable documents include utility bills, rental agreements, or mortgage papers. Additionally, proof of prior qualifying health coverage for at least one day in the 60 days before the move is often required.

For a loss of health coverage, documentation must show the reason for the loss and the last day of coverage, such as a letter from a former employer or an insurance company notice. All submitted documents must be from a legitimate source, such as an insurer or employer, and typically need to be dated within 90 days of the qualifying event.

Steps to Enroll During a Special Enrollment Period

Individuals typically have a limited timeframe, often 60 days from the date of the qualifying event, to apply for or change their health insurance plan. For certain events, it may be possible to select a plan up to 60 days before the event occurs.

The avenue for applying depends on the type of coverage. For plans through the Health Insurance Marketplace, individuals can apply online at Healthcare.gov or contact the Marketplace Call Center. Those with job-based coverage should generally work through their employer’s human resources department. Some insurance companies may also allow direct enrollment outside the Marketplace if applicable to the specific plan.

The application process typically involves creating or logging into an account on the relevant platform. The qualifying life event must be reported, and the system will prompt for the required documentation to be uploaded or submitted. It is generally advisable to select a plan first and then submit the documents within 30 days. Coverage can begin based on when the plan is selected, but it cannot be used until eligibility is confirmed and the first premium payment is made.