As your life evolves, your health insurance should change accordingly. Make adjustments during Open Enrollment each year as your needs alter and adapt your coverage as your life does.
Report changes in income or household size so you can receive accurate financial support through Marketplace plans. In addition, plans can be changed any time during a Special Enrollment Period or following a qualifying life event.
Open Enrollment
Open enrollment is an annual period, usually held during autumn, during which employees can enroll or make changes to their health, dental and vision insurance plans. It also serves as the main opportunity to adjust benefits such as flexible spending accounts, 401(k) contributions and life insurance coverage.
At open enrollment, individuals can select the health plan that best meets their needs and budget. Each health insurance plan offers various tiers (Bronze, Silver, Gold and Platinum) with differing costs and networks of providers; as well as flexible payment options such as monthly premiums, co-pays and deductibles.
Additionally, during open enrollment the Marketplace offers financial aid to assist individuals afford their health plan. To be eligible for assistance individuals must meet certain income and household criteria; individuals who do not qualify can still purchase Marketplace plans any time of year.
If your employer provides insurance, they will likely set their own open enrollment dates. Most employers also allow an annual open enrollment period during which employees can add, drop or switch plans as well as other employer-sponsored benefits. It is essential to check and understand their rules and deadlines prior to making changes to coverage.
No matter whether your health insurance comes through your employer or Marketplace, switching during open enrollment requires having experienced an “qualifying life event”. Examples may include losing other coverage, moving, getting married or having a baby.
If you experience a qualifying life event, a special enrollment period allows you to purchase an individual market plan outside of regular open enrollment. These periods last 60 days from when your qualifying event occurred and to qualify, individuals must meet income and household criteria and show proof of a life event that would normally trigger open enrollment. Individuals can discover whether they qualify by reaching out to their marketplace or eHealth for verification and then using the Marketplace app online Marketplace application to buy one that fits their needs and budget.
Special Enrollment Periods
Health insurance under the Affordable Care Act allows Americans a window from November through January in most states in which to sign up, change, or renew individual marketplace coverage. If a major life event arises outside this timeframe, an extended enrollment period may apply; contact your state department of insurance to inquire.
The following events qualify for an enrollment period exemption:
*In certain instances, events like loss of employment, divorce, the birth of a baby and death can trigger Special Enrollment Periods in the marketplace. When these qualifying events occur, individuals have 60 days to shop around and select a plan – coverage may begin as early as the first of the following month, although most SEPs allow backdating their enrollment process.
As well as these qualifying events, people who lose their current plan due to breaking the law or an involuntary loss of coverage also qualify for a special enrollment period (SEP). People who change jobs but can’t choose an employer-sponsored plan due to layoff or downsizing also have an SEP period; individuals enrolled in family plans owned by their employers that were cancelled may also qualify.
In case your current individual Marketplace plan becomes unaffordable or no longer provides minimum value, you have an SEP to switch plans. In general, this only applies if there’s another plan which offers equal or superior benefits and cost for you.
Some SEPs require proof of life events such as moving, or changes in income or household size, that could potentially impact financial assistance (subsidies, cost sharing reductions and tax credits). While this verification process has recently been reduced from 100% of applications for SEPs made on or off exchange to only those made on/off exchange, insurers may still require this in certain instances; individuals who are denied assistance or experience glitches in the system may file an appeal.
Renewal
Auto-renewal allows you to stay with the same plan from last year during Open Enrollment, and possibly receive financial help if applicable. Any changes in income or household size that arise must be reported immediately so as to receive proper savings amounts; failing which, you might miss out and may owe back money when filing federal taxes later on. Report changes as soon as they happen or wait until receiving your renewal notice to do so.
Certain events qualify you for a Special Enrollment Period outside the regular open enrollment periods, like losing coverage or getting married. With such an SEP you may purchase or change an individual plan or Marketplace plan within 60 days after an event has taken place.
SEPs only apply to plans purchased through the Marketplace. They don’t cover private health insurance plans or government-sponsored plans like Medicaid or CHIP, nor other methods of enrolling such as employer group plans or individual markets outside the Marketplace. You can check if any qualifying events have taken place by looking at your renewal notice or calling your insurance provider directly.
Cancellation
Sometimes it makes sense to cancel your health insurance, but there are important factors you must keep in mind before doing so. A gap could occur between when you cancel and when your new plan takes effect; that could make health services and medications unaffordable for you. To minimize such a timeframe, try canceling on the last day of each month so your new coverage begins on day 1 of the following month.
Before cancelling your plan, it is essential that you understand its cancellation policies. Most health insurers offer online tools or require you to call their customer service department; in either instance, be sure to request written confirmation of cancellation as evidence in your records.
When cancelling an individual marketplace plan, it is essential to remember that any new plans purchased during open enrollment or special enrollment periods (i.e. both on- and off-exchange plans such as private health insurance or employer-sponsored coverage) may only be purchased at certain times or periods. It would also be worthwhile speaking with your state marketplace regarding special enrollment periods and cancellation rules for their market place plans.
Legal landscape surrounding health insurance cancellation can be complex, with federal regulations and state-level fines often clashing against one another. Therefore, understanding these distinct nuances is vital in order to effectively cancel your health plan.
Life is full of changes, and your health insurance should adapt with them. From job changes and moves, to marrying or having children, finding an insurer that meets both your healthcare and financial goals should help meet those shifting needs. By carefully considering all the available options before selecting one for yourself.