Marketplace Insurance: Navigating Status Changes

If you have Marketplace insurance and your status changes, you can update your application online, by phone, or in person. You can make changes to your application during the yearly Open Enrollment Period (November 1–January 15). Outside of Open Enrollment, you can change your plan if you qualify for a Special Enrollment Period, which occurs after certain life events such as losing health coverage, moving, getting married, having a baby, or adopting a child. It is important to report changes to your status to ensure you are receiving the correct amount of savings towards your plan.

Reporting changes to the marketplace

You can report changes to the Marketplace by updating your application online, by phone, or in person. You cannot, however, update your application by mail.

Online

To update your application online, log in to your HealthCare.gov account and choose the application you want to update. Click "Report a Life Change" on the left-hand menu and read through the list of changes. Click "Report a Life Change" again to get started. You will then be able to select the kind of change you want to report and navigate through your application to make the necessary changes.

By Phone

To update your application by phone, contact the Marketplace Call Center, and a representative will help you update your application.

In Person

You can also update your application in person by finding someone in your community who can work with you to make changes to your application.

Changes

Changes you can report include moving, getting married, having a baby, or income changes.

Cancelling your marketplace plan

You may need to cancel your Marketplace insurance plan if you get other health coverage, or for other reasons. When and how you end your Marketplace plan depends on two things: the reason you're ending coverage, and whether you're ending coverage for everyone or just some people on the application.

If you're ending coverage for everyone on the application, your termination can take effect as soon as the day you cancel, or you can set the Marketplace coverage end date to a day in the future—for example, if you know your new coverage will start on the first day of the following month. If you're ending coverage for just some people on the application, in most cases their coverage will end immediately.

To cancel your Marketplace plan, log into your Marketplace account and select the "terminate coverage" option. Enter the required information. If you have a family policy and want to remove one person from the policy but keep coverage for others, log in to your Marketplace account, select the "reporting a life change" option, and enter the required information.

Making these changes through your Marketplace account will create a written record of your attempt to end coverage. Do not simply stop paying the premium for your Marketplace health plan as a way to terminate coverage. Non-payment will eventually cause your coverage to end, but your insurer might still try to collect from you if they think you just got behind on your premium payments.

If the government continues to pay premium tax credits on your behalf to your insurer for another month after you intended for your marketplace plan coverage to end, you might end up having to repay some or all of that amount to the IRS.

Moving to a new address

If you're moving to a new address, you will need to update your Marketplace application to get the best plan for your household and the right amount of savings. The steps you need to take will depend on whether you are moving to a different state or within the same state.

Moving to a different state

If you move to a new state, you will not be able to keep your current plan. It is important to report your move out of state immediately so that you can enrol in a new plan without a break in coverage and avoid paying for coverage that doesn't apply in your new state. To do this, you will need to start a new Marketplace application and enrol in a plan in your new state. The way in which you apply will depend on whether your new state uses HealthCare.gov or its own website.

Moving within the same state

If you move within the same state, you will need to update your application to report your change of address. Your coverage options and savings may change based on your new address, but this is not guaranteed. You will be notified if you need to pick a new plan.

How to update your application

You can update your application online, by phone, or in person. To update your application online, follow these steps:

• Log in to your HealthCare.gov account.
• Choose the application you want to update.
• Click "Report a Life Change" on the left-hand menu.
• Read through the list of changes, and click "Report a Life Change" to get started.
• Select the kind of change you want to report.
• Navigate through your application and report any changes to your income, household members, or address; new health coverage offers; and other information.
• After you're done, you'll get new eligibility results explaining your options to change plans.

Timeline

If you enrol between the 1st and 15th of the month, your new plan will typically start on the first day of the next month. However, if you apply after the 15th, your new coverage won't begin until the first day of the second month after your enrolment.

Losing health coverage

Losing your health coverage can be a stressful experience, but there are options available to ensure you get the coverage you need. Here are some steps and considerations to help you navigate a change in your health insurance status:

Understanding Your Options:

Firstly, it's important to know that you have alternatives. If you've lost your health insurance, you may be eligible for a Special Enrollment Period (SEP) to sign up for a new plan. This is a time outside the yearly Open Enrollment Period when you can enrol in health insurance due to specific life events, such as losing your coverage. You generally have 60 days following the loss of your previous coverage to apply for an SEP.

Marketplace Plans:

One option is to enrol in a plan through the Health Insurance Marketplace. These plans are available on healthcare.gov or through your state's marketplace. The plans are subsidized and based on your estimated total yearly income, including any unemployment insurance benefits and expected earnings if you return to work. You can preview plans and their estimated prices based on your income. Additionally, you may qualify for savings on your monthly premiums or a tax credit to lower your monthly insurance payment when enrolling in a Marketplace plan.

COBRA Coverage:

Another option is to sign up for COBRA coverage, which allows you to remain on your previous employer's health plan for a limited time, typically 18 months. However, COBRA coverage can be expensive since you usually pay the full premium yourself, plus a small administrative fee. On average, COBRA recipients pay more than $20,000 a year for a family of four. Nevertheless, COBRA may be a good option if you want to keep your doctor or prefer the coverage offered by your previous plan.

Short-Term Health Plans:

Short-term health plans are available for enrolment at any time. However, these plans can be restrictive and often don't provide clear information about what they cover. They may exclude pre-existing conditions from their policies, so it's essential to carefully review the terms and conditions before enrolling.

Medicaid or CHIP:

If you have a low income, you may be eligible for Medicaid or the Children's Health Insurance Program (CHIP), which provide free or low-cost health care. To find out if you qualify, check with your state's Medicaid office. They will consider your household's current monthly income, severance pay, and unemployment insurance benefits when determining your eligibility.

Act Promptly:

Remember that timing is crucial. Whether you choose a Marketplace plan or another option, be sure to act quickly. Tara Straw, a senior policy analyst, emphasizes that individuals typically have 60 days from the date they lost coverage to apply for a Special Enrollment Period.

Getting married

Understanding Marketplace Insurance and Marriage:

Marketplace insurance, also known as the Health Insurance Marketplace, offers various health insurance options for newlyweds. Federal, state, and private marketplaces provide an array of choices for couples who need to purchase their own insurance. One of the benefits of marriage is often gaining access to a family health insurance plan, which can be more affordable than individual plans.

Timing and Enrollment Periods:

When it comes to timing, getting married is considered a Qualifying Life Event (QLE) that triggers a Special Enrollment Period. This period typically lasts for 60 days after the QLE, allowing you to make changes to your current plan or enroll in a new one. It's important to note that you have a limited time frame to update your insurance information after getting married. You must submit your enrollment change from 31 days before to 60 days after your change in family status.

Options for Spousal Coverage:

After getting married, you have the option to enroll your spouse in your existing plan or join your spouse's plan if they have one. Spouses are not required to be on the same plan, so if you're both happy with your individual plans, you can choose to keep them. However, being on the same plan may be more economical for some couples. It's essential to compare the costs and benefits of different plans to make an informed decision.

Factors to Consider:

When navigating health insurance options as a married couple, consider factors such as copayments, coinsurance, out-of-pocket maximums, and whether your preferred doctors are in the plan's network. Additionally, the health status of both spouses can impact the type of plan that may be best suited for you. If one spouse has chronic health issues, a lower-deductible plan might be preferable, while the other spouse could opt for a higher-deductible, lower-cost plan.

Spouse Surcharge and Employer-Sponsored Plans:

Keep in mind that some employers may charge a spouse surcharge, making it more expensive to include your spouse on your plan. Additionally, if your spouse has access to an employer-sponsored plan, you are not obligated to choose that option. In some cases, a family health insurance plan through an employer can be more costly than a similar marketplace plan.

Reporting Changes to the Marketplace:

Remember to report your change in marital status to the Marketplace. You can do this by updating your Marketplace application online, contacting the Marketplace Call Center, or finding someone in your community to help you make the necessary changes.

Frequently asked questions