How to Switch Health Insurance Plans Mid-Year

Most people enroll in or change their health insurance plans during the annual Open Enrollment Period. But life does not always happen on a predictable schedule. If you experience a major life change, you may qualify for a Special Enrollment Period (SEP) that allows you to switch, enroll in, or update your health insurance plan outside of the regular enrollment window.

Qualifying Life Events That Trigger a Special Enrollment Period

A qualifying life event (QLE) is a significant change in your life circumstances that affects your health coverage needs. The following are some of the most common events that open a Special Enrollment Period:

• Loss of existing coverage: Losing employer-sponsored insurance, aging off a parent's plan at 26, losing Medicaid or CHIP eligibility, or having a COBRA subsidy expire all qualify. Voluntarily dropping coverage does not.
• Marriage or divorce: Getting married allows you to enroll in a new plan or add your spouse. Divorce may qualify you if you lose coverage through your former spouse's plan.
• Having or adopting a child: A birth, adoption, or foster care placement triggers a 60-day SEP to add your new dependent and adjust your plan.
• Moving to a new area: Relocating to a new zip code or county where different plans are available qualifies you for a 60-day enrollment window.
• Changes in income: If your income changes and you gain or lose eligibility for premium tax credits or Medicaid, you may qualify for a Special Enrollment Period.
• Other qualifying events: Becoming a U.S. citizen, leaving incarceration, or being affected by a natural disaster can also trigger eligibility.

How to Enroll During a Special Enrollment Period

Once a qualifying life event occurs, you typically have 60 days to select a new plan through the ACA Marketplace (some events allow only 30 days, so it is important to act quickly). You will need to report the life event on HealthCare.gov or your state Marketplace and provide documentation to verify your eligibility. This may include a marriage certificate, a letter confirming loss of coverage, a birth certificate, or proof of your new address.

Important Tips for Mid-Year Switches

When switching plans mid-year, keep in mind that your deductible and out-of-pocket spending typically reset with your new plan. This means any amounts you have already paid toward your previous plan's deductible will not carry over. Consider this when deciding whether to switch, especially if you have already incurred significant medical expenses. Also verify that your doctors and medications are covered under the new plan before finalizing your enrollment.

Navigating a mid-year plan change can be confusing, and missing your enrollment window means waiting until the next Open Enrollment. Resilience Health Advisors can help you determine whether you qualify for a Special Enrollment Period and guide you through the entire switching process. Contact us now to make sure you do not miss your window.