When One Spouse Drops Off ACA: What Happens to the Other’s Coverage?

Navigating the complexities of health insurance can be daunting, especially when dealing with major life changes like when one spouse drops their coverage. If you’re in this situation, it’s essential to understand how it impacts your own ACA health insurance.

Dropping Off ACA Coverage

When your spouse drops off their ACA plan, your own coverage typically will continue as is. This is because ACA plans are individual policies, and each person is responsible for enrolling in and paying for their own coverage.

Enrollment Periods

However, if you need to make changes to your ACA plan, such as adding or removing dependents, you’ll need to do so during the annual Open Enrollment period, which typically runs from November 1st to January 15th. Outside of Open Enrollment, you can only make changes to your plan if you qualify for a Special Enrollment Period (SEP). SEPs include events such as losing other health coverage, getting married or divorced, or having a child.

Specific Case Example

Let’s consider the case mentioned in the post. When the spouse drops off their ACA plan and transitions to Medicare, the other spouse’s plan will continue as before. However, there are a few things to keep in mind:

Premium changes: The premium for the other spouse’s plan may change since they are now the sole policyholder.
Dependent coverage: If the spouse who dropped off their plan was a dependent on the other’s plan, they will no longer be covered as a dependent.
Family plan vs. individual plan: If the couple previously had a family plan, the remaining spouse may now have an individual plan. This can affect the cost and coverage options available.

Seek Expert Advice

It’s crucial to seek professional guidance from a licensed insurance agent when making changes to your ACA coverage. They can assess your specific situation and help you determine the best course of action, whether it’s continuing your current plan, enrolling in a new one, or exploring other options.

Remember, it is crucial to stay informed about your health insurance coverage to make timely and informed decisions. If you have any questions or concerns about changes in your household and how they may impact your ACA plan, reach out to a qualified insurance professional for expert assistance.