Special enrollment opportunities

Changing plans — what you need to know

You can change plans for next year during Open Enrollment (November 1-January 15). After Open Enrollment ends, 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 may:
  • Have a limited number of health plan categories to pick from (instead of all 4)
  • Need to select a new plan within the same plan category as your current plan
  • Be allowed to change plan categories under certain circumstances

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 extra 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.
Silver plans may also be available if you’re eligible for a premium tax credit and can enroll through a Special Enrollment Period based on estimated household income.

Losing cost-sharing 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 enroll in 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 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.
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