When Is the Right Time to Change Your Marketplace Plans

Choosing the right health insurance plan through the Marketplace can feel overwhelming. But knowing when you can change your Marketplace plans is just as important as picking the right coverage. If you miss the right window, you might have to wait months before you can switch plans, which could leave you with inadequate coverage or higher costs.

This post will guide you through the key moments when you can change your Marketplace plans, explain how qualifying life events affect your options, and help you understand the different Marketplace enrollment periods. By the end, you’ll know exactly when and how to make changes to your health insurance coverage.

Calendar showing key dates for Marketplace enrollment

Understanding Marketplace Enrollment Periods

The Marketplace offers specific times when you can sign up for or change your health insurance plans. These are called Marketplace enrollment periods. The two main types are:

• Open Enrollment Period

This is the annual window when anyone can enroll in a Marketplace plan or change their existing plan. It usually runs from November 1 to December 15, but dates can vary by state. During this time, you can compare plans, update your information, and select the coverage that fits your needs for the upcoming year.

• Special Enrollment Period

Outside of open enrollment, you can only change your Marketplace plans if you qualify for a special enrollment period. This happens when you experience certain life changes, known as Qualifying Life Events.

Knowing these periods helps you avoid gaps in coverage or unexpected costs.

What Are Qualifying Life Events?

Qualifying Life Events (QLEs) are specific changes in your life that allow you to enroll in or change Marketplace plans outside the usual open enrollment period. These events reflect significant shifts in your health coverage needs.

Common QLEs include:

• Losing other health coverage (like losing a job-based plan)

• Getting married or divorced

• Having a baby or adopting a child

• Moving to a new area with different Marketplace options

• Changes in your income that affect your eligibility for subsidies

• Becoming a U.S. citizen or gaining lawful presence

  
  

When one of these events happens, you typically have 60 days from the date of the event to update or change your Marketplace plan.

Example

If you lose your job and your employer stops providing health insurance, you qualify for a special enrollment period. You can then sign up for a Marketplace plan within 60 days, even if the open enrollment period has ended.

When You Should Consider Changing Your Marketplace Plan

Even if you are currently covered, there are times when switching plans makes sense. Here are some situations to watch for:

• Your health needs change

If you develop a new medical condition or start a new treatment, you might want a plan with better coverage for your medications or specialists.

• Your financial situation changes

If your income increases or decreases, you might qualify for different subsidies or need a plan with different premiums and out-of-pocket costs.

• Your family situation changes

Marriage, divorce, or having a child can affect your coverage needs and eligibility.

• You move to a new state or county

Marketplace plans vary by location. Moving might give you access to different plans or prices.

• Your current plan changes

Sometimes insurers change plan benefits or premiums. If your plan becomes more expensive or less comprehensive, it’s worth reviewing your options.

How to Change Your Marketplace Plan

When you know you want to change your plan, follow these steps:

1. Check if you are in an enrollment period

   Confirm if you are in the open enrollment period or qualify for a special enrollment period due to a QLE.

   
   

2. Gather necessary documents

   For special enrollment, you may need proof of your qualifying life event, like a marriage certificate or proof of loss of coverage.

   
   

3. Log in to your Marketplace account

   Review your current plan and available options.

   
   

1. Compare plans carefully

   Look at premiums, deductibles, copayments, and coverage for your medications and doctors.

   
   

2. Submit your application

   Choose your new plan and complete the enrollment process.

   
   

3. Confirm your coverage start date

   Coverage usually begins the first day of the month after you enroll, but this can vary.

Tips to Avoid Missing Your Chance to Change Plans

• Mark your calendar for open enrollment dates and deadlines for special enrollment periods.

• Report life changes quickly to the Marketplace to trigger your special enrollment period.

• Review your plan annually during open enrollment to make sure it still fits your needs.

• Use Marketplace tools to compare plans and estimate costs before making a decision.

  
  

Changing your Marketplace plan at the right time can save you money and ensure you have the coverage you need. Keep track of the Marketplace enrollment periods and be aware of Qualifying Life Events that allow you to make changes outside of open enrollment. Taking action promptly after a life change helps you avoid gaps in coverage and unexpected expenses.

The WellFund's Patient Advocates can assist with your enrollment and plan changes. Call them today at 855.365.9300.