Q. If I didn’t make changes to my Marketplace plan and just let it auto-renew for January, am I stuck with it for the rest of the year?
A. After open enrollment ends (on January 15 in most states), you can’t switch to a different plan unless you experience a qualifying life event that triggers a special enrollment period.
In most states, you can pick a different plan between December 16 and January 15 and it will take effect in February. In that case, the auto-renewed plan will cover you in January and you’ll start over with the new plan on February 1 (keeping in mind that if you incur any out-of-pocket costs in January, they will not transfer to the new plan; you’ll be starting over with new out-of-pocket costs when the new plan begins).
After the end of open enrollment, a special enrollment period can be used to switch to a different plan. But in most cases, the available options are limited to another plan at the same metal level as the existing plan.1
Most special enrollment periods require a specific qualifying event, but some are ongoing, including enrollment opportunities for American Indians and Alaska Natives and low-income subsidy-eligible applicants.
Can I pick a new health plan if my old one terminated and the exchange picked a new one for me?
If your health plan terminates at the end of the year, you’ll qualify for a special enrollment period that continues for the first 60 days of the new year. This generally applies even if you’re mapped to a new plan by the exchange or by your insurance company. As noted above, if you pick the new plan after the deadline for getting a January 1 effective date (December 15 in most states, but later in several states), you’ll have the plan that was auto-selected for you in January, and your new plan choice will take effect in February.
The special enrollment period triggered by year-end plan terminations is limited to situations in which the insurer terminates your plan, entirely exits the exchange or the full individual market in your area, or makes a major change to plan designs, such as switching everyone from PPOs to HMOs. Changes to the benefit structure (ie, different deductibles, copays, coinsurance, etc.), provider networks, or covered drug list would not warrant a special enrollment period. Neither would premium changes, which is why it’s important to pay attention to the notices your insurer and the exchange send you in the fall, so that you’re not caught off guard by an unexpected premium change in January.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
Footnotes
- Special Enrollment Period (SEP) Overview for the Federally-facilitated Marketplace. Centers for Medicare and Medicaid Services. April 2020. ⤶
