Thanks to the Affordable Care Act (ACA), more Americans than ever before have access to quality health care, even if you’re self-employed or your employer doesn’t offer health care coverage. If you’ve signed up for an ACA plan only to realize that you need more or less coverage, it’s possible to switch your health insurance plan. Though health insurance companies have to follow a few regulations that limit the time period in which you can switch your plan, you may qualify for an exception to these rules.
Before you decide to switch, make sure you read Benzinga’s comprehensive guide about what you need to know before you switch health insurance plans.
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What You Need Before You Switch
Switching your health insurance involves two steps: Cancel your current plan and sign up for a new plan. With very few exceptions, you can cancel your health insurance plan at any time for any reason. However, if Open Enrollment hasn’t arrived, you may have trouble finding an immediate plan to cover you after you cancel. Though anyone can get health insurance during Open Enrollment periods, you must have a qualifying event to sign up for a plan outside of Open Enrollment.
Understanding Open Enrollment, what you need in a health care plan and how to qualify for a Special Event Period can make the process of switching your health insurance plan much simpler.
Figure Out if You’re Eligible to Enroll for a New Plan
Everyone is eligible to buy a new health care plan during the ACA’s Open Enrollment period. This year, the Open Enrollment period is scheduled to begin November 1, 2019 and closes on December 15, 2019. Plans purchased during Open Enrollment go into effect at the beginning of January 2020.
If Open Enrollment isn’t open, you may sign up for a new health care plan if you qualify for a Special Enrollment period. Some of the events that can trigger a Special Enrollment period include:
Loss of Current Health Care Coverage
If you lose your job and your employer-sponsored health care coverage, you graduate from college and lose your student coverage or you turn 26 and lose coverage through a parent’s plan, you qualify for a Special Enrollment period. You may also qualify if you lose eligibility for Medicare, Medicaid or CHIP.
Changes in Your Household
You may qualify for a Special Enrollment period if you have a baby, adopt a child or the main policyholder in your household passes away. You can also qualify for a Special Enrollment Period if you get married or finalize a divorce.
You Change Your Residence
You may qualify for a Special Enrollment period if you move for school or work or you move from temporary to permanent housing. Your new residence must be in a different zip code to trigger a Special Enrollment period — you can’t just move across town.
You Escape a Domestic Violence Situation
If you’re a survivor of domestic abuse or spousal abandonment and you want to enroll in your own plan to escape dependence on your abuser, you can qualify for a Special Enrollment period. Your dependents can also get on your new plan.
You Missed Open Enrollment Due to a Disaster or Accident
If you missed Open Enrollment due to the onset of a coma or other sudden cognitive disability or due to a natural disaster like an earthquake, hurricane or flood, you can qualify for an Open Enrollment period.
You Experience Another Major Life-Changing Event
If you were recently released from prison, became a U.S. citizen or gained membership in a federally-recognized tribe, you qualify for a Special Enrollment period.
If you qualify for a Special Enrollment period, you have 60 days from the onset of your qualifying event to enroll. To begin the enrollment process, contact the Marketplace Call Center at 1-800-318-2596. The representative will ask you a few questions about your circumstances and will help you enroll in a plan.
If you currently have a plan and you qualify for a Special Enrollment period, your representative can help you cancel your current plan and make sure you don’t have any coverage gaps.
If you don’t qualify for a Special Enrollment period, you have a few options to get covered. If you believe that your rejection was incorrect, you can file an appeal. If a representative accepts your appeal, you’ll gain access to a Special Enrollment period.
To complete an appeal, download your state’s appeal form, fill it out, and mail it to the following address: Health Insurance Marketplace, Attn: Appeals, 465 Industrial Blvd., London, KY 40750-0061.
You should also include eligibility documentation with your appeal form. While this isn’t required, it will help your appeal go through faster.
If you can’t get a Special Enrollment Period through an application or an appeal, your next best option is to enroll in a temporary insurance plan that provides coverage until Open Enrollment period arrives. Temporary health insurance plans only bridge gaps in coverage — you shouldn’t see that as a long-term health insurance solution because it has a number of restrictions that aren’t found in ACA-compliant plans.
You can also purchase a standard or Medicare supplemental insurance plan to fill minor gaps in coverage until Open Enrollment opens again. If you’d like to learn more about short-term health insurance options, check out our review of the best temporary health insurance plans.
What You’re Looking for in a New Plan
Before you start searching for a new plan, you want to consider what exactly you’re looking for. Think about what your current plan lacks — some areas you might want to look at include:
- Deductibles and copay percentages
- Monthly premiums
- Mental health coverage
- Pregnancy coverage and maternity care options
- Drug coverage options
Create a wish list of everything you need in a plan and use your needs to guide you when you compare plans and speak with representatives from health insurance companies.
Documents You’ll Need
If you do qualify for a Special Enrollment period, you’ll need to provide documentation to a representative that backs up your claims. The specific documentation you need depends on which qualifying life event you claim.
Some examples of documentation a representative might ask you to provide include:
- Birth, adoption or legal guardian status through a birth certificate, adoption record or court order that grants guardianship or a child support order.
- Marriage license, including proof of coverage for at least one spouse.
- Loss of coverage documentation from either your employer or your insurance provider that states when coverage ends. If you lose health insurance because you turn 26, you’ll need some form of proof of qualifying health insurance coverage valid for at least 60 days before your 26th birthday. If you lost coverage because you graduated from college and were on a school-sponsored plan, contact your health insurance company and request a document that confirms your plan cancellation date.
- Divorce or legal separation papers, including a clause that ends spousal health care provisions, along with documentation that proves that you had health insurance through your spouse for at least 60 days prior to your separation.
- If you’ve moved out of your previous zip code, you’ll need to provide proof of your former health insurance coverage as well as some form of documentation that confirms your new address. This can include a lease or rental agreement, a letter from your current or future employer that states that you moved for your employment, official school documentation that includes information on your dormitory or student housing address or an official U.S. Postal Service change of address confirmation.
- Release from prison or another form of incarceration. A document from the Department of Corrections can confirm your release date, as well as any outstanding parole certificates.
If you have a different qualifying life event, your Marketplace representative will help you decide what type of documentation you need to provide.
Changing Your Health Insurance: Step-By-Step
Changing your health insurance online or by phone is a relatively simple process that you can finish in as little as an afternoon. After you qualify for a Special Enrollment period, follow these simple steps to switch your health insurance.
Step 1: Log onto your Healthcare.gov account
Log into your Marketplace account through Healthcare.gov. Click the green button that says “Continue” as soon as you log in.
Step 2: Begin a new health insurance application
Choose your current health insurance application under the tab titled “Your Existing Applications.”
Step 3: Report your qualifying event
Select the section titled “Report a Life Change” from the menu on the left-hand side of the page. Read through the changes in the drop-down list and click on the situation that applies to you. If your new situation qualifies you for a Special Enrollment period, you’ll move to the Marketplace, where you can begin shopping for plans.
Step 4: Compare plans and shop around
Once you’re in the Marketplace, you can look at plans and compare coverage options available to you. Pull out your wishlist and narrow down your options based on your coverage needs and your budget. Once you’ve selected a plan, submit your application for enrollment.
Check out our top choices for healthcare providers nationwide:
Step 5: Complete your “to-do” list
When you finish your application, the Marketplace will present you with a “to-do” list of steps that you need to take to finalize your application. You may have to upload documentation that confirms your qualifying life event and you may have to enter information on your assets or income or select policy preferences. Complete all of your required steps and click “Final Review” to confirm your new enrollment.
Step 6: Cancel your current coverage
If your current health insurance isn’t through the ACA, you’ll need to cancel your coverage independently. As a general rule, you can cancel any kind of medical insurance or dental insurance at any time for any reason.
However, you don’t want to cancel your plan before you’re covered with a new plan because this will leave you with a gap in coverage. Call your insurance provider after you’ve enrolled in a new plan and request a cancellation. Request written documentation from your policy provider that confirms that your plan is canceled and when your coverage ends. Keep this documentation for your records.
Step 7: Make sure your policy is actually canceled
For the first few months after your policy cancellation, double-check your bank and credit card statements to make sure that you aren’t still paying for your old plan. If your old insurance company still attempts to charge you, send your former representative the documentation stating when you canceled your policy and request that the charge is reversed.
Getting the Health Care You Need
Beginning in 2019, the Trump administration removed the individual mandate penalty that charged fees to uninsured men and women. However, living without health insurance can leave you and your family on the hook for expensive medical treatment and care in the event of an accident or emergency. If you’re currently uninsured, take the time today to review your options when it comes to getting covered — your body (and your wallet) will thank you.