In the United States, there are two set times each year when you can make changes to your current insurance plan or sign up for a new one: the Open Enrollment Period and the Special Enrollment Period. The Open Enrollment Period (OEP) typically runs from November 1 to January 15 of the following year, though some states have adjusted dates. During the OEP, anyone can make changes to their health insurance, regardless of whether a qualifying life event has occurred.
Outside of the OEP, you can still make changes to your health insurance plan when you experience a qualifying life event, such as getting married, moving to a different ZIP code or county, or having a child. This creates a Special Enrollment Period (SEP), during which you typically have 60 days to make any necessary changes to your plan.
What You'll Learn
Losing health coverage
To qualify for a special enrollment period, the coverage you're losing must be considered minimum essential coverage. Short-term plans, for example, are not considered minimum essential coverage, so losing this type of plan does not trigger an SEP.
If you qualify for an SEP due to losing your health coverage, you will have a limited amount of time to enroll in a new plan. The special enrollment period typically lasts 30 to 60 days, depending on your plan, and it can begin 60 days before your old plan ends and continue for 60 days after. It's important to enroll in a new plan before your old plan ends to avoid a gap in coverage.
- You get laid off and lose your job-based health insurance.
- You get divorced and lose the health insurance your former spouse's job provided.
- You turn 26 and are no longer eligible for coverage under your parent's health plan.
- Your spouse dies, causing you to lose the health insurance they provided.
- You move out of your current health plan's service area and it won't cover you at your new address. Note that moving to a new area is only a qualifying event if you already had minimum essential coverage at your previous location.
- Your employer cuts back on your work hours, making you ineligible for job-based health insurance.
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Getting married
Qualifying Life Event
Marriage is considered a "qualifying life event" that triggers a Special Enrollment Period (SEP). This period allows you to make changes to your health insurance plan or enroll in a new plan. The SEP typically lasts for 60 days from the date of your marriage. It is important to act quickly, as the window for making changes is limited.
Adding Your Spouse to Your Plan
You can add your spouse to your existing health insurance plan during the Special Enrollment Period. Contact your insurance provider or benefits administrator to initiate the process. You will need to provide proof of your marriage, such as a marriage certificate.
Choosing a Plan
When deciding on a health insurance plan, you have the option to be on the same plan as your spouse or to maintain separate plans. Factors to consider when choosing a plan include cost, deductibles, out-of-pocket maximums, and whether your preferred doctors are included in the plan's network.
Employer-Sponsored Coverage
If one of you has employer-sponsored health insurance, you may be able to add your spouse to that plan. However, it is not mandatory for employers to offer spousal coverage, and there may be a spouse surcharge. Additionally, if you both have access to employer-sponsored plans, compare the benefits and costs to determine which option is best for both of you.
Marketplace Coverage
If employer-sponsored coverage is not available or suitable, you can explore health insurance options through the Health Insurance Marketplace. The Marketplace offers a range of plans, and you can compare and choose the coverage that best suits your needs.
Income and Household Changes
If your household size or income changes due to your marriage, your eligibility for financial assistance or subsidies may also change. Be sure to report any income or household changes to your insurance provider to ensure you receive the correct amount of savings and benefits.
Deadlines and Restrictions
It is important to be mindful of deadlines and restrictions when making changes to your health insurance after getting married. The Special Enrollment Period is typically limited to 60 days after your marriage, and you will need to provide proof of your marriage. Additionally, check with your state's Marketplace for any specific restrictions or exceptions, such as those for Native Americans, Alaska Natives, or victims of domestic abuse.
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Having a baby
If you have your own healthcare plan, you and your child will have coverage immediately following the birth. If you or your spouse have health insurance through an employer, you will be able to change your plan right away. You will have 60 days from the date of birth to buy health insurance (for you and the baby) from a marketplace, but only 30 days to be added to your employer or your partner's employer's job-based health plan.
During the Special Enrollment Period, you can choose a new health insurance plan or modify your current one to include your newborn. This can be done through your employer (if you have employer-sponsored insurance), directly with your insurance company, or through the health insurance marketplace. You will typically need to provide documentation of the birth, such as a birth certificate or hospital records, as part of the enrollment process.
It is important to note that pregnancy is not considered a qualifying life event that allows you to change your insurance plan. However, the baby's birth is a qualifying event, and you will have a 60-day special enrollment period from the date of birth.
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Moving to a new address
Understanding Insurance Enrollment Changes:
Firstly, it's important to understand that moving to a new address can be considered a "qualifying life event" that allows you to make changes to your insurance plan outside of the usual open enrollment period. This is known as a Special Enrollment Period (SEP). During the SEP, you typically have a window of 30 to 60 days to make changes to your insurance plan or enroll in a new plan.
Moving Within the Same State:
If you're moving within the same state, you will need to update your insurance provider with your new address. While your coverage options and savings may not change significantly, it's important to review your plan to ensure it still meets your needs in your new location. Contact your insurance provider or log in to your online account to report the address change.
Moving to a Different State:
When moving to a different state, it's crucial to understand that insurance plans and requirements vary across the US. Most plans are tied to a specific state, and you may need to enroll in a new plan to ensure coverage in your new state. Even if your current insurance provider operates in your new state, you will likely need to purchase a new policy that complies with the insurance laws of that state. Contact your current provider to understand their coverage options in your new state and compare them with other providers.
Steps to Enroll in a New Insurance Plan:
To enroll in a new insurance plan after moving, follow these steps:
- Shop and Compare Plans: Research and compare different insurance plans available in your new state. Consider factors such as coverage options, provider networks, and costs.
- Gather Necessary Paperwork: Before applying for a new plan, ensure you have the required documents, such as social security numbers, immigration documents, income information, and federal tax returns.
- Apply for Health Coverage: Submit your application for the new insurance plan. You can usually do this through the official website of your state's health insurance marketplace or by contacting insurance providers directly.
- Provide Verification of Your Move: In some cases, you may need to provide proof of your new address. Acceptable documents may include a change of address confirmation, a driver's license or ID with the new address, a bill or bank statement with your new address, or a signed letter explaining why you cannot provide other documents.
- Complete Enrollment: Once you've selected a plan and provided the necessary information, complete the enrollment process by paying your first month's premium.
Remember, it's important to act promptly when changing your insurance after moving to prevent any gaps in coverage. Review your current plan's guidelines and contact your insurance provider to understand their specific requirements and timelines for address changes and plan adjustments.
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Income changes
Impact on Eligibility:
- Income changes can affect your eligibility for health insurance plans, especially if your income falls below a certain threshold. A decrease in income may qualify you for a Special Enrollment Period, allowing you to enroll in a health insurance plan outside of the usual Open Enrollment Period.
- Special Enrollment Periods are typically triggered by significant life events, including income changes that make you eligible for different savings or coverage options.
Adjusting Your Plan:
- If you experience an income change while enrolled in a Marketplace plan, it is important to update your application as soon as possible. This includes reporting changes such as higher or lower income or changes in household members.
- Income changes may affect the coverage and savings options available to you. For example, a decrease in income may qualify you for more savings or lower monthly premiums. On the other hand, an increase in income may result in reduced savings or higher premiums.
- If you gain or lose household members due to income changes, you may need to add or remove individuals from your health insurance plan.
- In some cases, income changes may allow you to increase or decrease your plan's deductible. Adjusting your deductible can impact your monthly premium and out-of-pocket costs.
- Keep in mind that changing your deductible mid-year may affect the payments you have already made toward your current deductible.
Special Enrollment Periods:
- Special Enrollment Periods are typically triggered by qualifying life events, including income changes. During this period, you can make changes to your health insurance plan or enroll in a new plan.
- The length of the Special Enrollment Period can vary, but it is often 30 to 60 days from the qualifying life event. It is important to report income changes and update your application as soon as possible to take advantage of the Special Enrollment Period.
- During the Special Enrollment Period, you may be able to change plan categories or metal tiers, especially if your income change affects your eligibility for cost-sharing reductions or premium subsidies.
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Frequently asked questions
A qualifying life event is a major change that triggers a potential need for additional health insurance. This includes marriage, having a child, divorce, or loss of coverage due to job loss or your insurer discontinuing your existing plan.
Other qualifying life events include getting married, losing coverage due to divorce, losing eligibility for Medicaid, and exhausting your COBRA coverage.
The Special Enrollment Period is typically 30 to 60 days, depending on your plan, during which you can select a new plan or add a new dependent to your plan.
Every Affordable Care Act (ACA) plan is sorted into four metal tiers: Bronze, Silver, Gold, and Platinum.
Yes, you can change your health insurance after enrolling, but only during the annual Open Enrollment Period or if you experience certain qualifying life events that would qualify you for a Special Enrollment Period.