When Can You Switch Health Insurance?

The Annual Enrollment Window

Health insurance enrollment in the United States typically occurs during specific periods. The annual enrollment window is the primary opportunity for many individuals to make changes to their health insurance. This period allows for a review of current coverage and an evaluation of alternative options.

Marketplace/ACA Plans

The Affordable Care Act (ACA) Marketplace provides a structured environment for individuals and families to purchase health insurance. The annual Open Enrollment Period for these plans typically runs from November 1st to January 15th in most states. During this timeframe, individuals can enroll in a new plan, switch from an existing plan, or re-enroll in their current coverage. They can also add or remove dependents. Plans selected during Open Enrollment generally become effective on January 1st or February 1st.

Employer-Sponsored Plans

Employer-sponsored health plans also have an annual open enrollment period, with specific dates set by each employer. This period allows employees to review their company’s health benefit offerings and make adjustments to their existing coverage. Employees can enroll in a new plan, switch between options, or add/remove eligible family members. This is the designated time for making changes to job-based coverage without a specific life event.

Qualifying for a Special Enrollment Period

Significant life changes can open a pathway to modify health insurance coverage outside the annual enrollment window. This is known as a Special Enrollment Period (SEP), triggered by specific Qualifying Life Events (QLEs). Individuals typically have a 60-day window, either before or after the qualifying event, to enroll in a new health plan or make changes to an existing one.

Loss of Health Coverage

One common reason for an SEP is the involuntary loss of health coverage. This includes situations where coverage ends due to circumstances beyond an individual’s control.

Qualifying events include:
Losing job-based health coverage due to a job change, termination, or reduced hours.
An employer stopping health insurance offerings.
Expiration of COBRA continuation coverage.
Aging off a parent’s health insurance plan, typically at age 26.
A current health insurance plan being discontinued by the insurer.
Losing eligibility for student health coverage.
Divorce or legal separation resulting in loss of coverage from a spouse’s plan.

Proof of coverage loss, such as a letter from the previous insurer or employer, is often required.

Changes in Household

Changes within a household are also recognized as QLEs, impacting health insurance needs. These often involve a modification in family size or dependency status.

Qualifying events include:
Marriage, allowing newly married individuals to enroll in a new plan or join a spouse’s plan. Coverage can often be effective the first day of the month following marriage.
Divorce or legal separation, particularly if one party loses health insurance coverage.
The birth of a child, adoption, or placement of a child for foster care. These events allow parents to add their new dependent to an existing plan or enroll in a new family plan. Coverage for newborns or adopted children can often be retroactive to the date of birth or placement.
The death of a plan member, such as a spouse or dependent, permitting adjustments to remaining family members’ coverage.

Changes in Residence

Moving to a new permanent residence can qualify an individual for an SEP, especially if the move impacts access to their current health plan’s network or available plans. Health insurance plans are often geographically restricted, necessitating new coverage after a relocation.

Qualifying moves include:
Moving to a new county or state, or a different ZIP code within the same state, if the previous plan is no longer available.
Moves to or from a shelter or other transitional housing.
Moving to the U.S. from a foreign country or U.S. territory.
For students, a move to or from the place where they attend school.
For seasonal workers, moving to or from the place where they both live and work.

In many cases, individuals must demonstrate they had qualifying health coverage for 60 days prior to their move, unless moving from a foreign country or U.S. territory.

Changes in Income/Eligibility

Fluctuations in income or changes in eligibility for financial assistance programs can activate an SEP. These QLEs ensure individuals can access affordable coverage as their financial circumstances evolve.

Qualifying events include:
Gaining or losing eligibility for premium tax credits or cost-sharing reductions through the Health Insurance Marketplace due to an income change.
An income increase leading to loss of Medicaid or Children’s Health Insurance Program (CHIP) eligibility, making one eligible for a Marketplace plan.
A significant decrease in income making one newly eligible for subsidies.

Other Events

Several other specific situations can qualify individuals for an SEP. These events address unique circumstances that alter an individual’s coverage needs or options.

Qualifying events include:
Gaining U.S. citizenship or lawful presence.
Release from incarceration.
An employer newly offering an Individual Coverage Health Reimbursement Arrangement (ICHRA) or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA).
Becoming a member of a federally recognized tribe or an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.

Enrollment Rules for Government Programs

Government-sponsored health insurance programs operate under distinct enrollment guidelines. These programs are designed to serve specific populations, often with continuous enrollment options or specialized periods.

Medicaid and Children’s Health Insurance Program (CHIP)

Medicaid and CHIP primarily serve low-income individuals and families, with eligibility based on income relative to the federal poverty level. Enrollment is generally open year-round. Individuals who meet the income and other requirements can apply and enroll at any time.

Medicare

Medicare, the federal health insurance program for individuals aged 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease, has several specific enrollment periods.

Initial Enrollment Period (IEP)

The IEP is the first opportunity for most individuals to sign up for Medicare Parts A and B. This 7-month window begins three months before an individual’s 65th birthday, includes their birthday month, and extends for three months afterward. Enrolling during this time helps avoid potential late enrollment penalties for Part B.

General Enrollment Period (GEP)

For those who miss their IEP and do not qualify for a Special Enrollment Period, the GEP provides another chance to sign up for Medicare Parts A and B. This period runs annually from January 1st to March 31st. Coverage for those enrolling during the GEP typically begins the month after they sign up, but late enrollment penalties may still apply.

Medicare Special Enrollment Periods (SEPs)

Medicare also features its own set of SEPs for specific life events. A common Medicare SEP applies to individuals who delay Part B enrollment because they are still working past age 65 and covered by an employer-sponsored group health plan. This SEP allows enrollment without penalty when that employer coverage ends, typically providing an 8-month window.

Medicare Annual Enrollment Period (AEP)

The Medicare AEP, also known as the Open Enrollment Period, occurs each year from October 15th to December 7th. During this time, Medicare beneficiaries can make changes to their Medicare Advantage (Part C) plans and Medicare Part D (prescription drug) plans. Changes made during the AEP become effective on January 1st of the following year.