Orlando Harmon
Changing your medical insurance plan can be done for a variety of reasons, such as requiring more or less coverage, moving to a new area, or changes to your employment or family situation. The yearly Open Enrollment Period, typically from November 1 to mid-December, is when anyone can change their health insurance plan. Outside of this period, you may still be able to change plans if you qualify for a Special Enrollment Period, which can occur due to certain life events such as losing health coverage, moving, getting married, having a baby, or if your income falls below a certain amount. It is important to carefully consider your options when changing health insurance plans to ensure you have adequate coverage and understand the associated costs, such as monthly premiums, deductibles, copays, and coinsurance.
| Characteristics | Values |
|---|---|
| Time period | Open Enrollment Period: November 1 – January 15 |
| Special Enrollment Period: Outside of Open Enrollment | |
| Reasons | More or less coverage needed |
| Changes in employment or family | |
| Losing health coverage | |
| Moving | |
| Getting married | |
| Having a baby | |
| Adopting a child | |
| Household income changes | |
| Action | Log into Marketplace account |
| Update application | |
| Enroll in a new plan by December 15 for coverage starting January 1 | |
| Enroll by January 15 for coverage starting February 1 | |
| Pay the first premium for coverage to start | |
| Update information on the application to get the right amount of savings | |
| Compare different health insurance plans for the best coverage and payment options |
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What You'll Learn
You need more or less coverage
When it comes to medical insurance, you may find yourself in a situation where you need to adjust your coverage—either by increasing or decreasing it—to better suit your needs. Here are some factors to consider when deciding whether to opt for more or less coverage:
Frequency of Doctor Visits: If you find yourself visiting the doctor frequently and copays are becoming a financial burden, switching to a different plan with higher coverage may help keep your medical expenses under control. On the other hand, if you rarely visit the doctor and have a top-tier coverage plan, you may benefit from switching to a more modest plan to save on monthly premiums.
Life Changes: Certain life events, such as moving to a new area, changes in employment, or changes in your family situation, are often good triggers to review your financial situation and insurance coverage. These qualifying life events also allow you to change your health insurance coverage outside of the usual Open Enrollment Period.
Financial Considerations: Assess your financial situation and consider how much you can afford to pay for insurance premiums each month. If you're comfortable with higher monthly premiums, you may opt for a plan with lower deductibles and copays. Conversely, if you prefer to pay less each month, you can choose a plan with higher deductibles and copays, knowing that you'll pay more when you require medical services.
Preventive Care Services: Review the preventive care services offered by different insurance plans. Some plans may cover certain preventive services at 100%, which can help you maintain your health and potentially reduce future medical expenses.
Specialist Requirements: If you regularly see specialists, ensure that your insurance plan covers visits to these providers. Changes in your plan's network, such as your preferred doctors or specialists no longer accepting your insurance, can result in higher out-of-pocket expenses. Switching insurance plans may help lower your overall medical bills.
Remember, the right health insurance plan is unique to your personal circumstances. Consider your health needs, financial situation, and the specific coverage offered by different plans to make an informed decision about increasing or decreasing your coverage.
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Moving to a new area
If you're moving to a new area, you'll need to consider how your health insurance will be impacted. Firstly, if you're moving within the same state, you may not need to change your insurance plan. However, it's still important to report your change of address to your insurance provider and update your profile. Your coverage options and savings may not change significantly, but it's always worth checking to see if you need to make any adjustments to your plan.
On the other hand, if you're moving out of state, you will likely need to change your health insurance plan. This is because most health insurance plans and benefits are specific to certain states. By switching to a local plan, you can benefit from in-network providers, rather than relying on out-of-network benefits, which tend to be more expensive. If you purchased your current plan through the Health Insurance Marketplace (Obamacare), you will definitely need to switch to a new plan. However, if your health insurance is provided as part of your employment benefits package, you may not need to change plans, but it's still worth checking with your employer.
When moving to a new state, you will usually have a 60-day window during which you can select a new plan. Moving is considered a "qualifying life event", which means you are eligible for a special enrollment period outside of the usual open enrollment. During this period, you can pick a new plan through the federal marketplace, your new state's exchange, or another provider. It's important to act quickly to avoid any breaks in coverage and to ensure you are covered in your new location.
To enrol in a new plan, you will typically need to provide verification of your move, as well as personal information such as Social Security numbers, immigration documents, and employer and income information for all household members. You can usually complete the application process online and receive coverage from the following day or the first of the next month. Remember to terminate your old plan to avoid paying for unnecessary coverage.
While you're settling into your new area, it's a good idea to familiarise yourself with local doctors and hospitals, and then check that they are included in your new plan's network. This will ensure that you can access discounted care from in-network providers. Keep in mind that short-term health insurance can be a useful option to bridge the gap between your previous coverage and your new long-term plan.
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Changes to your employment
Leaving your job or transitioning jobs: When you leave your job, you will typically lose your employer-based health insurance coverage. This transition can impact your health insurance in several ways. Firstly, you might want to consider temporarily retaining your current coverage by speaking directly with your employer. They may be able to provide information about prolonging your current benefits or special coverage options. Secondly, it is crucial to be aware of the timing of losing your health coverage. Understanding the exact date will help you navigate the necessary steps to obtain new coverage. Lastly, you might be eligible for a Special Enrollment Period, allowing you to purchase an individual health insurance plan. This period typically lasts up to 60 days after losing your previous coverage.
Gaining new employment: When starting a new job, it is essential to understand the health insurance options provided by your new employer. Inquire about the specific health insurance plan they offer and whether it aligns with your needs. If you intend to continue visiting your current healthcare providers, ensure they are included in your new plan's network. If not, you may need to explore out-of-network care options during the transition. Additionally, consider the potential costs associated with your new plan. Understand the monthly premiums, deductibles, copays, and coinsurance to gauge the financial implications of your new coverage.
Changes in income: Alterations in your income level can impact your eligibility for specific health insurance programs or plans. For instance, if your income decreases, you may become eligible for government-sponsored programs like Medicaid, which provides free or low-cost health coverage for individuals and families below certain income thresholds. On the other hand, if your income increases, you may want to review your current plan to ensure it still aligns with your financial situation.
Changes in family structure: Events such as marriage, having a baby, or adopting a child can qualify you for a Special Enrollment Period, allowing you to adjust your health insurance plan outside of the standard Open Enrollment Period. Review your entire financial situation, including your new family structure, to determine if your current plan adequately meets your evolving needs.
Open Enrollment Period: Regardless of changes in your employment status, it is essential to be aware of the Open Enrollment Period, typically from November 1 to December 15 or January 15, depending on the year. During this period, you can shop for a new health insurance plan that better suits your needs. Compare plans based on monthly premiums, deductibles, copays, and the coverage provided for preventive care services and specialty appointments.
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Changes in your plan's network
Changes in your insurance plan's network can significantly impact your overall medical bills. If your preferred doctors or specialists stop accepting your insurance, you could be forced to pay significantly more out of pocket. Therefore, it is essential to review your plan's network of providers and ensure that your preferred healthcare professionals are included. You can do this by using tools such as Covered California's Shop and Compare Tool or by contacting the health insurance companies directly.
During the Open Enrollment Period, you have the opportunity to update your current health insurance plan to ensure it aligns with your needs. The Open Enrollment Period typically runs from November 1 to December 15 or January 15, depending on the source, but it may sometimes be extended. During this period, you can shop around for a new plan that better suits your requirements, including any changes in the plan's network.
If you experience significant life changes, such as moving to a new area or changes to your employment or family status, you may also be able to change your health insurance coverage during a Special Enrollment Period. A Special Enrollment Period is a time outside of the Open Enrollment Period when you can enroll in or change Marketplace plans. Life events that may qualify you for a Special Enrollment Period include losing health coverage, moving, getting married, having a baby, or adopting a child.
It is important to note that if you take no action to actively renew or change your health insurance plan during the Open Enrollment Period, you will likely be automatically enrolled in the same plan as the previous year. This automatic renewal typically occurs 30 days after the date on the renewal notice you receive in the mail. Therefore, if you are experiencing changes in your plan's network or other aspects of your coverage, it is crucial to take proactive measures to find a new plan that suits your needs during the Open Enrollment Period or a qualifying Special Enrollment Period.
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Renewal and automatic re-enrolment
If you have Marketplace coverage, you can renew your plan during the Open Enrollment Period. Renewal allows you to continue receiving the health coverage provided by your current plan for another year. To renew your plan, you may need to update your application with any changes in your household income and other relevant information. This ensures that you receive the appropriate savings and benefits associated with your plan.
If you do not actively renew or change your plan during the Open Enrollment Period, automatic re-enrolment may occur. This means that if you take no action by the specified deadline, you will be automatically enrolled in the same plan as the previous year, using the most recent household and income information on file. The deadline for automatic re-enrolment is typically December 15 for coverage starting on January 1 of the following year.
It is important to note that automatic re-enrolment may not occur in all cases. There may be instances where you need to actively renew or change your plan to maintain continuous coverage. Additionally, if your plan is terminating at the end of the year, you may need to select a new plan to avoid a lapse in coverage.
Outside of the Open Enrollment Period, there are still opportunities to make changes. Special Enrollment Periods are available following certain life events, such as losing health coverage, moving, getting married, having a baby, or adopting a child. These periods allow you to enrol in a new plan or make changes to your existing coverage.
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Frequently asked questions
You can change your insurance during the Open Enrollment Period, which usually runs from November 1 to January 15.
You can change your insurance outside of the Open Enrollment Period if you qualify for a Special Enrollment Period. You may qualify for a Special Enrollment Period if you experience a significant life event, such as losing health coverage, moving, getting married, having a baby, or adopting a child.
To change your medical insurance, you can compare different health insurance plans to find the best coverage for your needs and budget. You can use tools like Covered California’s Shop and Compare Tool or contact health insurance companies directly. Once you've found a new plan, you can enroll in that plan and cancel your previous coverage.
