Changing plans — what you need to know

Outside of Open Enrollment, you can change plans if you have a life event that qualifies you for a Special Enrollment Period.

  • If you qualify for a Special Enrollment Period and want to change plans, you may have a limited number of health plan “metal” categories to choose from (instead of all 4) during the Special Enrollment Period.
  • This means if you want to change plans during a Special Enrollment Period, you may need to select a new plan within the same plan category as your current plan, or wait until the next Open Enrollment if you want to change to a plan in a different category for the next plan year.

Types of Special Enrollment Periods with limited plan category choices

Enrollees and their dependents (including newly added household members) who qualify for the most common Special Enrollment Period types — like a loss of health insurance, moving to a new home, or a change in household size — will only be able to pick a plan from their current plan category.

For example, someone who’s 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 plan categories

It may be possible to change to a plan in a different plan category during a Special Enrollment Period under certain circumstances.

Becoming eligible for cost-sharing reductions

If you become newly eligible for special savings in the Marketplace called cost-sharing reductions (CSRs) and aren’t already enrolled in a Silver health plan, you can choose a plan in the Silver category to use your cost-sharing reductions.

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 their own group and enroll them in any plan for the remainder of the year. Note: This only applies to the new household member. Current enrollees can’t change plans.

If you can’t add new household members to your plan

If your plan’s rules don’t allow you to add new members to your plan, your family can enroll together in a different plan in the same category. If no other plans are available in your current plan category, your family can enroll together in a category that’s one level up or one level down.

An employer offer to help with the cost of coverage

Gaining access to an individual coverage HRA or a 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, make sure you enroll in a plan that starts by the date your individual coverage HRA or QSEHRA begins, unless your employer offers a later start date.

Special Enrollment Periods for complex situations

Some Special Enrollment Periods, like those due to misrepresentation or plan display error, gaining or maintaining status as a member of a federally recognized tribe or an Alaska Native Claim Settlement Act (ANSCA) Corporation shareholder, or other very rare situations, don’t limit your ability to choose a new plan during a Special Enrollment Period. Learn about Special Enrollment Periods for complex issues.