Reasons behind Switching Health Plans and Process to Accomplish It

Health Plans Process

Today an increasing number of Americans have access to quality health care, thanks to the Affordable Care Act. It is only due to the ACA that more Americans can obtain health coverage, even if their employers do not provide health insurance, or if they are self-employed. So, if you have signed up for an ACA plan and later on realize that you do not have adequate coverage, or you don’t require so much of coverage, then you can switch health plan. However, you need to follow a few regulations to switch your health plan. You can switch your plan only during a specific period, though you may qualify for an exception.

Things to Know Before Switching your Health Plan

You need to follow two vital steps to switch your plan, first, you need to cancel your existing plan, and then you need to sign-up for a new plan. You should know that you can cancel your existing health plan at any time for any reason, with quite a few exceptions. However, if it is not the Open Enrollment period, then you may find difficulty in immediately finding a plan to cover you. Obtaining health insurance during open enrollment is easy for everyone but to sign up for a health plan outside of Open Enrollment, you should have a qualifying event to sign up. Therefore, to ease and simplify the process of switching health plans, you should have a good understanding of Open Enrollment, your exact need in a health plan, the process of qualifying for a Special Enrollment, etc.

Check your Eligibility for Enrollment in a New Plan

It is quite clear that everyone is eligible to enroll in a new health plan during the ACA’s Open Enrollment period. The Open Enrollment period is generally a fixed period that starts on November 1 and ends on December 15 every year. Health plans purchased during this period became effective from January 1 of the next year. If the Open Enrollment period has ended, then you may sign-up for a new health plan only if you qualify for a Special Enrollment Period.

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The events that can trigger a Special Enrollment period are discussed below:

Loss of Existing Coverage

You can lose your existing coverage and qualify for the Special Enrollment period upon losing your job resulting in the loss of employer-sponsored health coverage, losing your student coverage after graduating from college, losing health coverage through a parent’s plan upon turning 26. You can also qualify for the Special Enrollment period if you lose eligibility for Medicare, Medicaid, or CHIP.

Addition or Reduction in Family Members

You can become eligible for a Special Enrollment Period if you have a baby, adopted a child, or if the main policyholder of your home expires. If you get married or finalize a divorce, then also you become eligible for a Special Enrollment Period.

Change in Residence

You may also become eligible for a Special Enrollment period if you need to change your home due to school or due to job. You may also move from a temporary house to a permanent house. To qualify for a Special Enrollment Period, your new residence must be in a different zip code.

Domestic Violence Survivor

If you have escaped domestic violence and are a survivor of spousal abandonment and wish to enroll in your plan to escape dependency of your abuser, then you become eligible for a Special Enrollment Period and your dependent can also get on your new plan.

Missed Open Enrollment due to Accident or Disaster

There is a chance that you might miss Open Enrollment, either due to sudden cognitive disability or due to the onset of a coma or due to certain natural disasters like an earthquake, flood, or hurricane. In all such circumstances, you qualify for an Open Enrollment period.

Experiencing Major Life-Changing Event

If you experience a major life-changing event such as became a U.S. citizen or gained membership in a federally recognized tribe, or you were recently released from prison, then you qualify for a Special Enrollment Period.

If you qualify for a Special Enrollment period due to any of the above-mentioned reasons, then you have 60 days from the onset of your qualifying event to enroll in a plan. You need to get in touch with the Marketplace Call Center and their representatives will help you enroll in a plan, Even, if you currently have a plan and you qualify for a Special Enrollment period, then also the representative will help you cancel your existing plan and enroll in a new plan without any coverage gaps.

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Documents Required

You are supposed to provide certain documents in support of your Special Enrollment eligibility to a representative that backs up your claims. The documents you may need depend on that qualifying life event you claim. Some of the documents examples that might be asked include:

  • Marriage license along with proof of coverage for at least one spouse.
  • Documents related to loss of existing coverage. Such documents can either be availed from your employer or your insurance carrier stating when your coverage ends.
  • Birth certificate, adoption or legal guardian status offered by courts that grants guardianship or a child support order.
  • Divorce or legal separation papers along with a clause ending spousal health care provisions. You will also need a document that proves you had health insurance through your spouse for at least 60 days prior to your separation.
  • Documents confirming your new address, if you have moved to a new zip code along with a proof of your former health insurance coverage.

Step-by-Step Guide for Changing your Health Insurance

Changing a health plan is a relatively simple and easy process that will not take much of your time. After qualifying for a Special Enrollment Period, you need to follow these simple steps to switch your health plan:

Step 1: You need to visit and log in to your marketplace account. After logging in you need to click on the “Continue” button.

Step 2: You need to choose your current health insurance application under the tab “Your Existing Applications.”

Step 3: Now you need to report your qualifying event be selecting the section titled “Report a Life Change” from the menu given on the left-hand side of the page. If you qualify for a Special Enrollment Period then you will move to the marketplace, where you can start shopping for health plans.

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Step 4: Compare plans and shop. If you are moved to the marketplace, then you can go through the different plans and compare the available coverage options. You can take into consideration all your requirements and narrow down your options depending upon your needs and your budget. After selecting a plan, you can submit your application for enrollment.

Step 5: After completing your application, you will be provided with a “to-do” list that you should do to finalize your application. In this step you may need to upload certain documents to confirm your qualifying life event and may also need to provide information on your income or assets or you may also need to select your policy preference. You are expected to complete all the required steps and click on “Final Review” to confirm your new enrollment.

Step 6: You will need to cancel your existing coverage if your current health plan is not through the ACA. You are allowed to cancel any type of medical or dental insurance at any time for any reason as per the general rule. However, if you don’t want to cancel your existing plan without having coverage due to a gap in coverage, then you can call your insurance provider after you have enrolled in a new plan and request for cancellation. You should request your insurance carrier to provide a written document to confirm that your policy has been canceled and your coverage ends.

Step 7: After policy cancellation, you need to ensure that your policy is canceled for the first few months. You can check your bank and credit card statements to ensure that you are not paying for your old plans. Incase if your old insurance company is still charging you, then you should send your former representative the documents that state about your policy cancelation.

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