You participated in the ACA annual open enrollment period and are all set with your new health insurance policy for next year. (Nice work!) But what if you’re having second thoughts?
Maybe you’ve learned your preferred healthcare provider isn’t in-network or your deductible feels unaffordable.
Can you change health insurance after open enrollment? Depending on your specific situation you may be able to:
- Switch to a different ACA-qualifying health plan outside of open enrollment.
- Obtain supplemental health insurance to help with a major medical deductible.
- Switch to a non-ACA qualifying short term insurance policy with lower monthly premiums, that include benefits limits and coverage exclusions such as for pre-existing conditions.
Even though the federal tax penalty for going without health insurance was eliminated effective January 1, 2019, you may still owe a state penalty for going without qualifying coverage. Keep that in mind as you review the options here.
When Can You Switch Health Insurance Plans?
Under the Affordable Care Act (ACA) there are three times when you can choose a new qualifying major medical health insurance policy:
During the Annual Open Enrollment Period
If you buy health insurance during open enrollment and change your mind, you can still make changes before open enrollment ends.
In most states, health insurance open enrollment for plans beginning Jan. 1, took place from Nov. 1 through Jan. 15.
During a Special Enrollment Period
You might be able to switch health insurance plans outside of open enrollment if you experience a qualifying life event that impacts your coverage such as getting married or divorced, having a child, moving to a new coverage area or losing job-based coverage.
Such events trigger what is called a special enrollment period, a limited period of time during which you can buy a new ACA plan. In most circumstances, special enrollment lasts 60 days from the qualifying life event.
If You Become Eligible for Another Form of Minimum Essential Coverage
If it’s no longer open enrollment and you don’t qualify for a special enrollment period, you can’t switch to a different ACA plan. However, you can see if you are eligible for another form of minimum essential coverage (healthcare.gov) such as Medicaid or TRICARE. You can enroll in many of these programs year-round if you qualify.
Still unsure? Find out if you can get health insurance now.
Can You Just Cancel Your ACA Plan?
Let’s say you want to switch health insurance plans halfway through the year and don’t qualify for special enrollment, but you’d still like to cancel your current major medical coverage. Is that an option?
Yes, it’s possible. However, it’s important to remember that going without comprehensive major medical coverage could leave you vulnerable to unexpected medical bills should you become sick or injured.
Instead of canceling your ACA plan and going without coverage, you may want to consider either keeping your comprehensive plan and adding supplemental coverage or enrolling in a non-ACA-qualifying short term medical policy as an alternative to going uninsured if you qualify.
Let’s look more closely at these options, both of which are available year-round in most states.
If You Can’t Switch ACA Health Insurance
If you’re worried about being able to afford your ACA deductible you’re not alone. A 2019 Kaiser Family Foundation poll reports that 34% of insured adults said they had difficulty affording their deductible.
It may seem counterintuitive, but if you can afford a bit more per month in premium, a supplemental health plan could help with out-of-pocket costs. That includes costs not covered by your major medical policy (such as out-of-network care) as well as the covered medical expenses you’re responsible for until you reach your major medical policy’s deductible amount.
Gap health insurance is a type of supplemental insurance that pays a fixed lump-sum benefit when you experience a covered accident or critical illness. With some policies, the benefit is paid regardless of whether or not your major medical policy pays – or how much – since the two insurance policies do not coordinate.
You can use the gap benefit to help pay your major medical deductible, coinsurance or even to help with other costs like housing, childcare or transportation.
Find out if gap plans are available and compare premiums and benefits.
Apply for Non-ACA-Compliant Health Insurance
If you ultimately find yourself without major medical insurance for whatever reason, you may want to look into non-ACA-compliant short term health insurance. Here’s what to know about short term coverage:
- Availability varies by state. Short term plans are available year-round in most states and provide temporary coverage for as few as 30 days and up to 364 days, depending on your state.
- Benefits may cover a range of medical expenses related to injuries and unexpected illnesses; however, most policies exclude coverage for pre-existing conditions and do not include the essential health benefits.
- You choose when to start your coverage – it’s available the day after you qualify and pay your first month’s premium – no waiting until the first of the month.
- Policies are not guaranteed-issue. You must be approved by the carrier to enroll, and your application may be denied due to pre existing conditions. Additionally, treatment related to pre-existing conditions is typically not covered.
- There are annual benefits maximums, so it is possible to “max out” your short term medical policy.
- Premiums may be lower because of benefits limits, coverage exclusions and denial of coverage to those with pre existing health conditions. Premiums also vary based on the benefits you select.
Compare the costs and coverage for short term medical insurance plans available to you.
What if You Can’t Afford Your ACA Plan Anymore?
What happens if you simply can’t afford your health insurance premium at some point in the coming year? If an ACA special enrollment period and other minimum essential coverage are not available options, you may want to consider non-ACA-compliant short term health insurance, but only if it fits both your financial situation and healthcare needs.
If you find yourself in a position where your current health insurance is unaffordable you don’t have to make these decisions alone and guess the best course of action.
Call [phone_number] to speak with a licensed agent to help you understand your health insurance options both on and away from the state-based and federally facilitated health insurance exchanges.
Summary + Next Steps
If you’re interested in changing health insurance after open enrollment for any reason, you do have some options: special enrollment, adding supplemental health insurance, or enrolling in lower-premium, non-ACA-compliant short term medical insurance and canceling your current coverage.
How to make the switch (and what to switch to) ultimately depends on your life circumstances and coverage needs. There are many resources available to help you decide.