I Bought a Health Insurance Policy But Now I Want to Change It, Can I?

The first open enrollment period to buy health insurance exchange plans – from October 31st 2013 to March 31st 2014 – is well under way. And while the launch of the new health insurance Marketplaces got off to a rocky start, enrollment is now operating much more smoothly, with the U.S. Department of Health and Human Services reporting that over 3 million people have now bought health insurance plans on the health insurance Marketplaces. Here at CHIR, we have received questions from Navigators who are helping consumers enroll in plans. They are finding that some of these new health plan policyholders now want to change to another plan. Can they cancel their policy? Can they change to a new policy? If they do change plans, will they still be able to receive the financial assistance they were deemed eligible for when they purchased the old plan? Selecting the right plan can be challenging, even in states that have implemented tools to help consumers understand and compare their plan choices. So for those who now want to change plans, we offer some guidance below. 

I enrolled in a plan that I now realize is not the best plan for me. Can I cancel my current plan and sign up for a new one?   

You can cancel your policy at any time. However, you cannot enroll in a new policy at any time and you may be left with a gap in coverage. You will only be able to enroll in a new plan under certain circumstances.

Specifically, federal guidance allows you to change plans during Open Enrollment, as long as you do so before your coverage under the plan you no longer want becomes effective. However, there have been reports that some Marketplace websites, including healthcare.gov, do not yet have the functionality to allow you to change plans after you have made a selection.

You should note, however, that if you do wish to change plans, you need to select your new plan by the 15th of the month if you want your coverage to start by the 1st of the following month. If you enroll or change plans between the 16th and the last day of the month, your coverage will start the first day of the second following month. If your income has not changed during the Open Enrollment period, your eligibility for premium tax credits and/or cost-sharing reductions for the new plan will also not change.

If you have a Marketplace plan and want to change to a new Marketplace plan outside the Open Enrollment period, you are only entitled to do so if your income increases or decreases enough to change your eligibility for premium tax credits and/or cost-sharing reductions. See FAQ 44 in CHIR’s Navigator Resource Guide for more information on income levels and eligibility for premium tax credits and/or cost-sharing reductions.

If you are dropping a plan you bought outside the Marketplace, you are only eligible to enroll in a Marketplace plan during the Marketplace’s Open Enrollment period OR if you experience a change in one or more of a certain set of circumstances that entitles you to a 60 day Special Enrollment opportunity. See FAQ 33 in our Navigator Resource Guide for more information on when consumers without Marketplace plans can enroll in a Marketplace plan. Changes in circumstances include things like: changing jobs, losing your job, getting married, and having a baby. For a full list of Special Enrollment triggers, see FAQ 34 in the Navigator Resource Guide.

With funding from the Robert Wood Johnson Foundation, we here at CHIR have developed a Navigator Resource Guide  to provide navigators with answers to consumers’ frequently asked questions. In the next month, CHIR will release an update to the Navigator Resource Guide to incorporate questions we’ve received, like the one above, as well as others addressing post-enrollment questions that may arise as consumers start to use the plans they’ve bought. Stay tuned to CHIRblog for more FAQs from the Guide.

 

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