When Can I Change My Health Insurance Plan?

You can change your marketplace health insurance plan during the annual open enrollment period, which runs from November 1 to January 15 in most states. However, certain life events may qualify individuals for a special enrollment period, allowing for changes to be made outside the usual cycle.

Learn about qualifying life events ,as well as tips to consider when you change health insurance.

Key Takeaways You may need to change your health insurance if your provider network changes, there’s an extreme life event or if your healthcare needs change. You can switch plans without penalty outside of the open enrollment period if you experience a qualifying life event and trigger a special enrollment period. The adoption of a child, loss of a job or a change in residence are a few examples of qualifying life events that would trigger a special enrollment period. The federal tax penalty for those without health insurance ceased on January 1, 2019 but a tax penalty at the state level may still apply depending on where you live.

Why Would I Need To Change My Health Insurance Plan?

Alterations in your provider network, abrupt changes in your life and expanding healthcare needs may demand a change in your insurance.

Changes in Your Network

Health insurance companies frequently update their network of doctors, hospitals and specialists. Such changes could mean your preferred medical professional is no longer in-network, potentially leading to higher out-of-pocket costs if you want to remain with that provider. Considering a plan change might be in your best interest to maintain access to your preferred providers.

Changes to Your Life Situation

Life events such as marriage, giving birth, relocation or losing coverage through your employer will require you to revisit your health insurance needs. For instance, moving might lead to a change in available providers, while job loss could mean losing employer-sponsored coverage.

Age milestones can play a factor as well. For instance, those turning 26 are no longer able to stay on their parent's health insurance coverage, meaning they will need to buy their own health insurance plan.^[1]

The Need for More or Less Coverage

As individuals age, develop health conditions or undergo lifestyle changes, they may need a new health insurance plan that will meet their current medical needs. Some may require more comprehensive plans with broader services and lower out-of-pocket costs, especially if facing chronic conditions or surgeries. Conversely, those enjoying good health and fewer medical visits might opt for basic plans with higher deductibles to save on premiums.

Regularly assessing personal health needs ensures you're not overpaying for unnecessary coverage or under-insured for potential medical events.

When Can I Change My Health Insurance Plan?

The primary time to enroll in, switch or drop a marketplace health insurance plan is during the annual open enrollment period, which runs from November 1 to January 15 in most states.^[2] Outside of this window, modifications are usually permitted only if you qualify for a special enrollment period (SEP) due to significant life events.

Note: Medicare will have its own enrollment periods depending on the type of Medicare plan you choose.

How To Change Health Insurance Plans

You have a couple of options if you want to change your health insurance: open enrollment or a qualifying life event making you eligible for the SEP.

Change a Health Insurance Plan During Open Enrollment

Changing your health insurance during open enrollment will involve logging into your marketplace account. Most states will use the federal health insurance marketplace but some states will have their own marketplace where you can view your plan information. In either case, you should be able to navigate to an open enrollment tab and begin the process.

The marketplace will ask you for information about you, your spouse and any dependants you may have. This information will include your age, smoking habits, income and possibly the estimated usage of your health insurance. All of this data is then used to provide you with a list of applicable health insurance plans. From here, it’s a simple matter of choosing the policy that suits your needs and paying your first premium.

Change a Health Insurance Plan After Open Enrollment

To change plans through a special enrollment period and you enrolled through the federal exchange, first access your marketplace account and select your active application under "Your Existing Applications." From there, click on "Report a Life Change" from the side menu. You'll then choose and detail the specific change you're reporting. If your updated eligibility indicates you qualify for a special enrollment period, you'll have the opportunity to browse and select a new plan.

To wrap up, ensure you address all the tasks on your online to-do list, make any necessary adjustments to tax credits and finalize your choices by completing the "Final Review" step.

Keep in mind that if your state has its own marketplace website, the exact steps may vary slightly.

Considerations When Changing Health Insurance Plans

When choosing a new health insurance plan, it's vital to balance monthly premiums with anticipated medical costs such as deductibles, copays and coinsurance. Ensure the plan covers your specific health needs, including preventive care, maternity, mental health and prescriptions. Before finalizing, confirm that your preferred doctor or healthcare system is within the plan's in-network providers, either by consulting your doctor or reviewing the plan's details.

Can I Change My Health Insurance Plan During Special Enrollment Periods?

You can change health coverage during special enrollment periods, which are activated when an individual experiences a significant life event, such as getting married, gaining U.S. citizenship or moving to a new location. Since these periods occur in conjunction with that life event, it also means that is one of the only ways you can switch plans outside of the open enrollment period. Keep in mind that you will usually have 60 days to choose a new healthcare plan once you've qualified for special enrollment.^[3]

What Events Allow Health Insurance Changes?

The U.S. government lists several specific events that would cause eligibility for a special enrollment period, such as changes in household size, residence and coverage status.

Changes in Household

If you get married, have a child through birth or adoption or place a child in foster care, these are considered changes in your household that qualify for a SEP. The death of someone on your plan that leads to you losing your healthcare is also a qualifying event.

Changes in Residence

Moving to a new ZIP code, county or coming to the U.S. from another country can qualify you for a special enrollment period. If you're relocating due to school, taking up seasonal work or moving from or to a shelter, these changes in residence count too. However, simply moving for medical treatment or vacations doesn't qualify.

Loss of Health Insurance

Losing your existing coverage, whether if it was an employer-based plan, a policy you purchased on the marketplace or Medicaid, should qualify as an event that triggers a special enrollment period. Being offered a health reimbursement arrangement (HRA) or a qualified small employer health reimbursement arrangement (QSEHRA) may also be considered a reason for updating your health insurance plan. Both of these are benefits offered by employers to help with healthcare costs.

Other Qualifying Changes

Other life events that can trigger a special enrollment period may include:

• Officially joining a federally recognized tribe
• Gaining U.S. citizenship
• Leaving incarceration
• Joining or leaving the AmeriCorps State and National, Volunteers in Service to America (VISTA) or National Civilian Community Corps (NCCC)

What Should I Consider When Canceling My Health Insurance?

When canceling your health insurance, know that dropping coverage can result in a state tax penalty if you live in California, the District of Columbia, Massachusetts, New Jersey and Rhode Island. Although Vermont does have a health insurance mandate, no tax penalty exists. The federal tax penalty was dropped effective January 1, 2019.^[4] Of course, you also risk paying for medical costs entirely out of pocket if you need to go to the doctor or the emergency room.