Outside of open enrollment, you can only change plans if you qualify for a special enrollment period.
If you qualify for a special enrollment period and want to change plans, you can:
- you have a limited number of health plan categories to choose from (instead of all 4)
- you need to select a new plan within the same plan category as your current plan
- You will be allowed to change plan categories under certain circumstances
types of special enrollment periods with limited plan category options
Enrollees and their dependents (including newly added household members) who qualify for the most common types of special enrollment period, such as loss of health insurance, moving to a new home, or change in household size, only they will be able to choose a plan from their current plan category.
for example, someone who is already enrolled in a bronze health plan (and wants to change plans) will only be able to select a new plan from the bronze category.
circumstances that allow you to change your plan category
It may be possible to change to a plan in a different plan category during a special enrollment period under certain circumstances.
become eligible for cost-sharing reductions
if you are eligible for additional savings in the marketplace called cost-sharing reductions (csrs) and you are not already enrolled in a silver health plan, you can choose a plan in the silver category to use your cost-sharing reductions.
Silver plans may also be available if you are eligible for a premium tax credit and can enroll through a special enrollment period based on estimated household income.
lose cost share reductions
If you’re enrolled in a silver health plan and lose your cost-sharing reductions, you’ll qualify for a special enrollment period. If you want to change plans, you can sign up for a bronze, silver, or gold plan that meets your needs and fits your budget.
new household members
If your household size increases due to marriage, birth, adoption, foster care, or court order, you can choose to add the new dependent to your current plan or add them to your own group and enroll them in any plan for the remainder. of the year. note: this only applies to the new household member. current members cannot change plans.
if you can’t add new household members to your plan
If your plan rules don’t allow you to add new members to your plan, your family can enroll in a different plan in the same category. If there are no other plans available in your current plan category, your family can enroll in a category that is one level higher or one level lower.
an offer from the employer to help with the cost of coverage
Getting access to an individual coverage hra or qsehra from your employer to help with coverage costs doesn’t limit your ability to choose a new plan during a special enrollment period. however, be sure to enroll in a plan that begins on the date your individual hra or qsehra coverage begins, unless your employer offers a later start date.
special enrollment periods for complex situations
some special enrollment periods, such as due to misrepresentation or error in plan display, obtaining or maintaining status as a member of a federally recognized tribe, or as a shareholder in an Alaska Native Claims Settlement Law Corporation (ansca), or other very rare situations, will not limit your ability to choose a new plan during a special enrollment period. Learn about special enrollment periods for complex issues.