How to Change Health Insurance Outside of Open Enrollment: A Guide for ACA Marketplace Policyholders

In the United States, the Affordable Care Act (ACA) has made it possible for millions of Americans to access affordable health insurance coverage through HealthCare.gov or state-based marketplaces. However, it is important to understand that there are specific rules and timelines for changing health insurance plans, including limitations on when you can make changes outside of the annual Open Enrollment Period.

Can’t Cancel Current Plan and Enroll with “Qualifying Life Event”

One common misconception is that individuals can cancel their current health insurance plan and enroll in a new one with a “qualifying life event” at any time. Unfortunately, this is not the case. Qualifying life events, such as marriage, having a baby, or losing health insurance coverage through an employer, only allow individuals to make changes to their coverage during specific enrollment periods, including Special Enrollment Periods (SEP).

When You Can Change Health Insurance Outside of Open Enrollment

There are limited circumstances under which individuals can change health insurance coverage outside of Open Enrollment. These include:

Loss of coverage: If you lose health insurance coverage through an employer or other source, you may be eligible for a Special Enrollment Period to enroll in a new plan.
Change in income or household size: If your income or household size changes significantly, you may be eligible for a Special Enrollment Period to make changes to your coverage or apply for Medicaid or CHIP.
Moving to a new state: If you move to a new state, you will have a Special Enrollment Period to enroll in a plan in your new state’s marketplace.

What to Do if You Need to Change Health Insurance Outside of Open Enrollment?

If you need to change health insurance coverage outside of Open Enrollment but do not qualify for a Special Enrollment Period, there are a few options available to you:

Contact your insurance company: Reach out to your current health insurance company and explain your situation. They may be able to help you find a more suitable plan within their network or offer other options.
Seek professional assistance: If you are unable to resolve the issue with your insurance company, you can seek professional assistance from a licensed health insurance agent or broker. They can help you navigate the healthcare marketplace and find a plan that meets your needs.
Consider short-term health insurance: Short-term health insurance plans are not as comprehensive as ACA-compliant plans, but they can provide temporary coverage for a limited period of time.

Remember, it is always important to consult with a licensed health insurance agent or broker to discuss your individual situation and determine the best course of action.