Can You Change Your Health Insurance Plan After Open Enrollment?

Most individuals are familiar with the annual Open Enrollment Period, which is the primary window for selecting or changing health insurance plans. A common question arises, however, about the possibility of altering one’s health insurance plan outside of this designated time.

Understanding Open Enrollment and Special Enrollment Periods

Open Enrollment is the yearly period when most people can enroll in a new health insurance plan, change their existing coverage, or renew their current policy. This annual timeframe, typically occurring in the fall, ensures that individuals have a regular opportunity to review and adjust their health coverage, with new plans usually becoming effective on January 1 of the following year. The system of open enrollment helps balance the risk pool, encouraging both healthy and less healthy individuals to enroll, which can contribute to more stable premiums for everyone. While open enrollment is the standard, certain circumstances allow for changes outside this period through what is known as a Special Enrollment Period (SEP). A SEP is a specific, limited timeframe that opens up when an individual experiences a significant life event. These periods exist to provide flexibility for those whose lives undergo unforeseen or planned changes that directly affect their health coverage needs.

Qualifying Life Events for a Special Enrollment Period

A Special Enrollment Period is triggered by specific “qualifying life events” (QLEs) that indicate a change in an individual’s health insurance needs.

• Loss of existing health coverage: This can include losing employer-sponsored coverage due to job loss, aging off a parent’s plan upon turning 26, or the termination of coverage due to divorce or legal separation where health insurance is also lost. Loss of eligibility for Medicaid or the Children’s Health Insurance Program (CHIP) also constitutes a qualifying event.
• Changes in household size: Getting married allows individuals to enroll in or change plans, as does the birth or adoption of a child, or placing a child for foster care. The death of someone on your health plan can also qualify you for a SEP, particularly if it results in a loss of coverage for other household members.
• Change in residence: Moving to a new ZIP code or county, thereby gaining access to new health plan options. This also applies to individuals moving to the United States from a foreign country or a U.S. territory.
• Change in income: A change in income that affects eligibility for subsidies or certain government programs like Medicaid can open a SEP.

For most qualifying life events, individuals typically have a window of 60 days before or 60 days after the event to enroll in a new plan.

Steps to Change Your Plan During a Special Enrollment Period

Once a qualifying life event occurs, individuals need to take specific steps to change their health insurance plan. The initial step involves gathering necessary documentation to verify the qualifying event. For instance, a marriage certificate is required for marriage, a birth certificate or adoption paperwork for a new child, or a termination letter from an employer for job loss. Most individuals will apply for a new plan through the Health Insurance Marketplace, accessible via HealthCare.gov, or through their employer if applicable. After submitting the application, individuals may be asked to provide the supporting documents, usually within 30 days of selecting a plan; coverage generally begins on the first day of the month following plan selection, though start dates can vary.

Limited Options Outside of Special Enrollment Periods

If an individual does not experience a qualifying life event, options for changing or enrolling in comprehensive health insurance plans are very limited outside of the annual Open Enrollment Period. In such scenarios, individuals typically must wait until the next open enrollment to make changes or secure new coverage. However, some alternatives exist for those without a SEP.

Individuals with low income may qualify for Medicaid or the Children’s Health Insurance Program (CHIP), which have year-round enrollment periods and do not require a qualifying life event. Another option is short-term health insurance, which provides temporary, limited coverage for unexpected medical events. It is important to note that short-term plans are not considered comprehensive under the Affordable Care Act, often exclude pre-existing conditions, and do not cover essential health benefits like preventive care or mental health services. Federal rules now limit these plans to a maximum initial contract term of three months, with a total coverage period of no more than four months including renewals.