Health insurance can be enormously beneficial when you need it, but it can also be a little challenging and confusing to navigate. If you’re currently enrolled in a plan, you may wonder if there’s any way to adjust your coverage outside of the open enrollment period.
If you’re asking yourself, “When can I change my health insurance?” the good news is that there is a degree of flexibility built into your plan. However, you have to meet certain criteria to qualify for mid-year changes.
While employers can typically adjust their coverage at any time, there are restrictions around exactly what they can change. They may also face penalties for altering their plans once they’re in place. Employees are usually permitted to make more changes, but they’re encouraged to only do so during open enrollment.
Need to make an adjustment sooner? Today, we’re sharing how this process works and how to determine if you can make a health insurance change outside of the allotted window.
When Can I Change My Health Insurance?
Let’s take a look at how the process works for employees vs. employers.
Employees
Timeline-wise, employees don’t have quite as much leeway when it comes to changing their health insurance plans. In general, there are two distinct times that you’re allowed to switch plans or make changes to your current plan. These include:
- The open enrollment period
- A special enrollment period
For most insurance providers, the designated open enrollment window runs from November 1 to December 15. However, each state will set its own dates, so check with your provider to verify your time.
During this period, you’re free to search for different health insurance coverage options. You can also renew your current plan if you don’t need to make any changes to it. You aren’t limited in the number of changes you can make, and you’re free to update it as much as you need to during this time.
Once everything is in place, your coverage will usually begin on January 1 or February 1, depending on the time of your enrollment. From that point onward, you won’t be able to make any changes to the plan you’ve chosen until the next open enrollment period occurs one year later. The only exception will be if you have a qualifying life event.
What Employees Can Change
Employees can make changes to their health insurance plans if they experience a change in their life status, described below. The changes you make will directly correlate to the type of life update you’ve experienced.
Qualification Requirements to Follow
If you need to make changes to your health insurance coverage outside of the open enrollment period, there are certain steps you need to follow to make sure you stay in compliance with your provider and avoid penalties.
Employees
Employees who want to make mid-year changes must do so during a special enrollment period. This period can occur at any time during the year, but only those who have experienced a qualifying life event can participate.
Qualifying life events include:
- Giving birth, adopting a child, or placing a child up for adoption
- Getting married, divorced, or legally separated
- Experiencing a death in the family
- Losing another type of coverage (e.g. turning 27 and losing parental coverage)
- Starting, ending, or losing employment
- Moving to a new county or zip code
- Gaining or losing Medicare or Medicaid coverage
- Leveraging Health Insurance Portability and Accountability Act (HIPAA) special enrollment rights
Other, less-common qualifying events that apply include becoming a U.S. citizen, leaving incarceration, gaining membership in a federally-recognized tribe, or becoming an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder. You may also qualify if you’ve recently started or ended service as a member of AmeriCorps State and National, VISTA, or NCCC.
When to Make the Change
Most providers give employees 30 to 60 days after their qualifying life event to make changes to their health insurance plan (or purchase a new plan). During this time, you can shop for new plans and compare multiple plans.
Note that the coverage start date is based on the life event. Here’s a quick look at the most common life changes, and their associated timelines:
- Giving birth, adopting a child, or placing a child up for adoption: Coverage starts the day of the event
- Getting married: Coverage starts the first day of the month after you enroll
- Being denied Medicaid or CHIP coverage: Coverage starts the first day of the month after you enroll
- Losing other healthcare coverage: Coverage starts the first day of the month after you enroll and/or after other coverage ends
Learn More About Changing Your Health Insurance
Are you still wondering, “When can I change my health insurance?” We understand how complex this step can be, and we’re here to help.
If you believe you qualify for a special enrollment period, we can walk you through the steps required to add Meritage Medical Network to your insurance plan. We have more than 2,100 private physicians located throughout Marin, Napa, Fresno, Madera and Sonoma counties, and we’re here to give you access to the quality, affordable care you need.
Get in touch with us today to learn more!