Switching Health Insurance: Steps To Take

Changing your health insurance plan can be done for a variety of reasons. The process is not overly complicated, but there are some important steps to follow. Firstly, it's important to understand the difference between the Open Enrollment Period and the Special Enrollment Period. The former is the annual period when anyone can change their health insurance plan for any reason, typically from November 1 to mid-January. During this time, you can shop around for a new plan or accept your current provider's renewal offer. On the other hand, the Special Enrollment Period is a time outside the Open Enrollment Period when you can sign up for health insurance due to certain qualifying life events, such as losing health coverage, moving, getting married, having a baby, or income changes. During this period, you usually have 60 days to switch or update your plan.

Check if you can change your health insurance plan

There are two main windows of opportunity to change your health insurance plan: the yearly Open Enrollment Period and a Special Enrollment Period.

Open Enrollment Period

The Open Enrollment Period is the time of year when anyone can change their health insurance plan, for any reason. It typically runs from November 1 to December 15 or January 15, and the plan you choose will begin on January 1 or February 1, depending on when you enroll.

Special Enrollment Period

A Special Enrollment Period is a time outside the yearly Open Enrollment Period when you can sign up for health insurance if you've had certain life events, including:

• Losing health coverage
• Moving
• Getting married
• Getting divorced or legally separated
• Having a baby
• Adopting a child
• Starting, ending, or losing a job
• A death in the family
• Changes to your income or household

If one of these events applies to you, you’ll usually have 60 days to switch to a new plan or make changes to your existing one.

Checking if you can change your health insurance plan

To check if you can change your health insurance plan, you should first determine whether you have had any of the qualifying life events listed above. If you have had a qualifying life event, you can then update your application online, by phone, or in person (but not by mail) to see if you are eligible for a Special Enrollment Period.

You can also compare plans by talking to your existing health insurance provider, your broker, or visiting your state’s health insurance marketplace. In some cases, you will need to provide evidence of your qualifying life event before enrollment is complete.

Understand the difference between Open Enrollment and Special Enrollment periods

Open Enrollment and Special Enrollment are two different periods during which you can make changes to your health insurance plan. The main difference between the two is that Open Enrollment is an annual period during which anyone can make changes to their insurance plan, while Special Enrollment is a period triggered by a qualifying life event that allows you to make changes outside of Open Enrollment.

Open Enrollment is typically the only time of year when you can sign up for or change your health insurance plan. The Open Enrollment period varies depending on the type of insurance and your provider. For example, Medicare open enrollment usually runs from October 15 to December 7 each year, while open enrollment for individual market health insurance typically runs from November 1 to December 15. If you have insurance through your employer, the Open Enrollment period can vary but is usually in the autumn so that the new coverage begins on January 1 of the following year.

During Open Enrollment, you can switch to a different health insurance plan, add supplemental coverage, or opt out of any optional coverage. Many people make changes during this period to manage their insurance costs or improve their coverage. It is important to pay attention to any actions or decisions required by the enrollment deadline, as you may need to take specific steps to continue your existing coverage.

Special Enrollment Periods, on the other hand, are triggered by qualifying life events such as losing your health coverage, having a baby, getting married, moving to a new ZIP code, or getting divorced. During a Special Enrollment Period, you can enroll in a health insurance plan outside of the annual Open Enrollment Period. You typically have 60 days before and/or after the qualifying event to make changes to your insurance plan. It's important to note that you must provide proof of eligibility for a Special Enrollment Period, and you must have had minimum essential coverage before the qualifying event to qualify.

In summary, Open Enrollment is the annual period during which anyone can make changes to their insurance plan, while Special Enrollment is a period triggered by a qualifying life event that allows for changes outside of Open Enrollment. Understanding these enrollment periods is crucial for making informed decisions about your health insurance coverage.

Learn what counts as a qualifying life event

A qualifying life event is a change in your life situation that allows you to purchase health insurance outside of the regular annual ACA open enrollment period. This is known as a special enrollment period.

There are four basic types of qualifying life events: loss of health coverage, changes in household, changes in residence, and other qualifying events.

Loss of Health Coverage

This includes losing existing health coverage, such as job-based, individual, or student plans. It also covers losing eligibility for Medicare, Medicaid, or the Children's Health Insurance Program (CHIP). Additionally, if you are turning 26 and will be losing coverage through a parent's plan, this is considered a qualifying life event.

Changes in Household

Changes in household include getting married, separated, or divorced, as well as becoming a parent through birth, adoption, or fostering. It also includes the death of someone on your health insurance policy.

Changes in Residence

Changes in residence refer to moving to a different zip code or county, which may result in a change in the health plan options available to you. This also includes students moving to or from school and seasonal workers moving to or from their work location. Moving to or from a shelter or transitional housing is also considered a qualifying life event.

Other Qualifying Events

Other qualifying events include changes in income that affect your eligibility for coverage, becoming a member of a federally recognized tribe, or gaining US citizenship. Beginning or ending service with AmeriCorps and being released from incarceration are also considered qualifying life events.

It is important to note that getting a new job or changing jobs within an organization is typically not considered a qualifying life event, unless it results in a loss of insurance coverage.

Compare health insurance plans

Comparing health insurance plans can be complicated, but there are several key factors to consider when choosing the best plan for you and your family. Here are some steps to help you compare health insurance plans:

Understand the Different Types of Health Insurance Plans:

The most common types of health insurance policies are HMOs, PPOs, EPOs, and POS plans. Each type has different features regarding provider networks, out-of-pocket costs, and referral requirements. Understanding these differences will help you choose the plan that best fits your needs.

Evaluate Your Medical Needs and Preferences:

Consider your past medical history and the type of treatment you've received. Think about whether you prefer a referral system of care or direct access to specialists. If you have preferred doctors, check if they are in the provider network of the plans you're considering. Additionally, weigh the importance of having a primary care physician who coordinates your overall medical care.

Compare Out-of-Pocket Costs:

Out-of-pocket costs include copays, coinsurance, deductibles, and premiums. Understand how these costs differ among the plans. Generally, plans with higher premiums tend to have lower out-of-pocket costs, and vice versa. Consider your expected medical needs and choose a plan that strikes a balance between premiums and out-of-pocket expenses.

Assess the Scope of Services and Benefits:

Review the summary of benefits for each plan to understand the scope of covered services. Some plans may offer better coverage for specific areas like physical therapy, fertility treatments, or mental health care. Ensure that the plan covers your regular and necessary care, such as prescriptions and specialist visits.

Consider Special Circumstances and Life Events:

Certain life events, such as losing health coverage, moving, getting married, having a baby, or changes in income, may qualify you for a Special Enrollment Period. During this period, you can make changes to your health insurance plan outside of the standard Open Enrollment window.

By following these steps and considering your personal circumstances, you can make a more informed decision when comparing health insurance plans. Remember to review the plan details thoroughly before making your selection.

Enrol in your chosen health insurance plan

Enrolling in a new health insurance plan is a straightforward process, but it requires careful consideration of your personal circumstances and preferences. Here is a step-by-step guide to help you enrol in your chosen health insurance plan:

Step 1: Understand the Open Enrollment Period

The Open Enrollment Period is the annual window during which anyone can change their health insurance plan for any reason. It typically runs from November 1 to either December 15 or January 15, depending on the state and the year. During this period, you can accept your current plan's renewal or shop around for a new plan. Remember that the plan you choose will usually take effect on January 1 or February 1, depending on when you enrol.

Step 2: Evaluate Your Needs and Preferences

Before enrolling in a new health insurance plan, it's essential to understand your specific needs and preferences. Consider the following:

• Monthly premiums, deductibles, copays and coinsurance: Decide whether you prefer higher monthly premiums with lower out-of-pocket costs or lower monthly premiums with higher deductibles, copays and coinsurance.
• Type of coverage: Review the preventive care services covered at 100% and the costs associated with specialty appointments. If you have specific health needs, such as pregnancy, mental health care, or prescription medications, ensure that these are adequately covered by your chosen plan.
• Network of providers: If you have preferred doctors or healthcare systems, confirm that they are included in the network of your chosen plan.

Step 3: Research and Compare Available Plans

You can research and compare health insurance plans in several ways:

• Same insurance provider: If you want to stick with your current insurance provider but change your plan, you can usually compare their plans online or contact their customer support team.
• Different insurance providers: Contact providers directly, speak to a broker, or use an online health insurance marketplace to explore options from multiple companies simultaneously.

Step 4: Enrol in Your Chosen Plan

Once you've decided on a new health insurance plan, it's time to enrol. You can typically enrol online, by phone, or in person. Here are some key points to remember:

• Deadlines: Enrol by December 15 for coverage starting January 1, or by January 15 for coverage starting February 1.
• Automatic enrolment: If you don't actively choose a plan by the deadlines, you may be automatically enrolled in a plan, which could be your current plan or a different one.
• First premium payment: To activate your new plan, you'll need to pay your first monthly premium. Insurance companies may have different payment processes, so follow their instructions.

Frequently asked questions