With the passage of the Affordable Care Act (ACA), also known as ObamaCare, thousands of Americans who previously did not have access to health insurance have now purchased coverage. Life changes happen to all of us, and many Americans have questions about when — and how — they can make changes to their health insurance purchased through the Health Care Marketplace.
You can change your health insurance each year during open enrollment. In addition, if you experience significant life changes, you may be eligible for a special enrollment period that allows you to change your insurance at that time as well. Americans can apply for Medicaid and CHIP at any time, regardless of enrollment periods.
Understanding Enrollment Periods
In general, once you purchase insurance you cannot make changes to your plan until the next enrollment period. There are two kinds of enrollment periods: annual open enrollment and a special enrollment period. This enrollment period typically lasts 60 days. Each year, every American is able to apply for coverage during an annual open enrollment period. This window allows individuals to make changes coverage, or to change plans entirely. The designated open enrollment period will vary each year depending upon where you obtain your plan – in the federal Marketplace, it will generally occur at the end and beginning of a new year. The proposed open enrollment period for 2015 coverage begins on November 15, 2014 and ends on January 15, 2015.
Some life changes make you eligible for a special enrollment period – a time outside of annual open enrollment when you can make changes to your coverage or plan. Some of these specific events include a move to another state, a change in family size (birth, marriage or divorce resulting in either the addition or loss of coverage from a spouse’s plan), the loss of a job, or the cancellation of your current health insurance plan by the company. These types of events often require new or modified health insurance coverage, which is why you are given a chance to make updates when these changes occur.
Moving to a New State
Each state has a separate marketplace, even if the state marketplace is run by the federal healthcare.gov site. Each state has specific approved insurers and approved plans that are available. Moving to a new state puts you in a new marketplace, and so you could need to select a new health insurance plan for that state.
In addition, some states are expanding Medicaid coverage to additional lower-income adults, and some are not. When you move to a new state, you may find yourself newly eligible – or newly ineligible – for Medicaid coverage. This would be a significant change to your insurance status and so you are allowed to choose a private marketplace plan if needed.
Changes in Family Size
Any change in family size will affect both your health insurance needs and your income eligibility for financial assistance in the marketplace. Health insurance coverage may be a priority for mothers-to-be who may want to take advantage of prenatal care prior to birth, or, after a new baby joins the family, the infant will need a lot of care to get a healthy start in life. Similarly, a marriage or divorce
will change the insurance needs and insurance premium of a family.
A change in family size also changes what financial assistance is available. The poverty level for 2013 (used in the 2014 open enrollment period to determine eligibility for financial assistance) was $23,550 for a family of four, however, a family of three would be lower. A family of five would be higher. As a result, the percentage of the poverty level your family meets will change with each addition or subtraction. This means that your financial assistance could go up or down accordingly. For more information on financial assistance and family size, see this chart.
Changes in Income or Cancellation of Existing Insurance
A change income, such as the loss of a job or a new, higher paying job, could affect how much financial assistance you are eligible to receive for plans in the Marketplace. Because these changes can dramatically affect your eligibility, you are given a special enrollment period in case you need to change plans. Additional subsidies may allow you to afford more coverage, or a reduction may cause you to need to change your plan to a less expensive option. A job loss may mean the end of a job-based insurance plan and special enrollment would allow you to fill out an application in the Marketplace and find out what subsidies and plans are available to you.
Families may face changes in coverage outside the open enrollment period when a company cancels a plan, a child ages out of CHIP, or an individual turns 26 and can no longer be covered on parental insurance. The cancellation or loss of a health insurance policy would give you a special enrollment period so that you can choose a new plan. It’s important to note that voluntarily cancelling a plan (or having it cancelled due to failure to make payments) does not qualify as losing coverage and is not cause for a special enrollment period.
Many large life changes can cause a significant change in health insurance needs or in the financial assistance available for private insurance in the marketplace. As a result, these events often result in a special enrollment period, allowing you to change your coverage or plan. If a special enrollment period is not available, you can still wait until annual open enrollment and change your coverage or plan at that time.