What if my individual health insurance plan is changing or being cancelled?
Starting 2014, most individual plans must offer new benefits and protections. Some plans are changing to include these benefits. Others are being cancelled.
This means if you have individual insurance now you face one of 3 situations when your current plan year ends:
- Your plan will be cancelled and you have other options
- Your plan will change to include the 2014 rights and protections
- You’ll have a chance to renew a plan without the new rights and protections
Find information below about your options under each of these situations.
If your plan is cancelled
If your insurance company cancels your plan, you have several options:
- Buy one of the plans the company offers in its place. It must allow you to buy any of its other plans available to you.
- Buy a new plan in the Marketplace. You may qualify for lower costs on monthly premiums and out-of-pocket costs based on your income. All Marketplace plans include the new rights and protections. Because your plan is ending, you qualify for a special enrollment period that lets you enroll in a plan outside the Open Enrollment period.
- Buy a plan outside the Marketplace.This can be a good option if you don’t qualify for lower costs based on your income. Most plans outside the Marketplace include the new rights and protections.
A catastrophic plan generally requires you to pay all of your medical costs up to a certain amount, usually several thousand dollars. These policies usually have lower premiums than a comprehensive plan, but cover you only if you need a lot of care. They basically protect you from worst-case scenarios.
How to get a catastrophic insurance plan
- Call 1-866-837-0677, a special phone number for people whose plans have been cancelled. (9 a.m. to 7 p.m. EST Monday through Friday) If you want to buy a catastrophic plan, we can provide information, plan options, and contact numbers.
- Download and fill out an application for a hardship exemption. Take this application to an insurance company selling catastrophic plans to show that you qualify to buy one. Be sure to include a copy of your cancellation notice. The insurance company will send the application to the Marketplace. We’ll confirm that you’re eligible for a hardship exemption later but you can buy a catastrophic plan right now. Note: When you fill out the form, be sure to answer that #13 is your reason for applying—that your individual policy has been cancelled and you feel you can’t afford coverage in the Marketplace.
- See a list of catastrophic plans available in your area. The list includes plan and company names and contact information. You can call the insurance companies directly to buy a catastrophic plan.
Important: If you buy a catastrophic plan, you can’t get lower costs based on your household size or income. You pay the standard price quoted by the insurance company.
If your plan changes to include 2014 rights and protections
If your insurance company tells you that your plan will change to include the new rights and benefits, you have 3 options:
- Accept the plan and renew it. The plan’s price may increase.
- Look for other plans in the Marketplace to compare your options. Because your plan is ending, you qualify for a special enrollment period that lets you enroll in a plan outside the Open Enrollment period.
- Look for other plans outside the Marketplace. This is a good option if you don’t qualify for lower costs based on your income. If you do qualify for lower costs, you can get those savings only if you enroll through the Marketplace.
If your plan lets you renew your plan without the new rights and benefits
If you have a plan that doesn’t offer the new rights and protections, you may be able to renew it.
Each state decides whether to allow insurers to do this, and then each insurer in those states decides whether to let people renew the coverage. Check with your insurance company to see if you can renew a plan without the new rights and protections. This opportunity is available only for plans that renew in 2014.
If your plan offers you the chance to renew this kind of plan, it must send you a notice explaining:
- Which rights and protections aren’t guaranteed in the plan
- That you can shop in the Marketplace, where all plans meet the new standards and you may qualify for lower costs based on your income
- That you may also buy new health insurance outside of the Marketplace, where financial assistance isn’t available but most plans provide the new consumer protections
- Where you can learn more about all your options
Once you have all the facts, you can make a decision about your next steps. You can renew your plan, shop for a new plan in the Marketplace, or buy a plan outside the Marketplace.
If your insurer offers to renew your coverage, the price for 2014 may change.
More Answers: Plan changes and cancellations
What if my plan ends outside open enrollment?
If your individual plan ends outside the open enrollment period, you can still use the Marketplace to get a new plan. Because the plan is ending, you get a special enrollment period.
Your Marketplace special enrollment period begins 60 days before your individual plan ends. If you wait until after you lose coverage to notify us, you have 60 days from the loss of the coverage to enroll in a new Marketplace plan.
If you miss this window, you’ll have to wait until the next open enrollment period in the fall of 2014 to sign up for a Marketplace plan.
The special enrollment period applies only at the end of a plan year or if your insurance company cancels your plan. Otherwise you must wait for the annual open enrollment period before you can buy insurance.
If you want to avoid a gap in coverage, you should sign up for a new plan by the 15th of the last month of your current plan’s coverage.
Do I have to use the Marketplace to buy a replacement plan?
No, but the rules are slightly different. You can choose to get coverage outside the Marketplace. Health insurance companies selling plans outside the Marketplace must allow you to have open enrollment 30 days before your individual plan renews. You'll have up to 30 days after your plan ends to sign up for a new plan outside the Marketplace.
Outside of an open enrollment period, you may not be able to buy or change health plans inside or outside the Marketplace unless you experience certain qualifying life events - for example marriage, birth of a child, or loss of other health coverage.
What if my plan is grandfathered?
The only individual plans that don’t have to provide some of the health care law’s protections are grandfathered individual plans. These plans have existed largely unchanged since the health care law was passed. These plans don’t have to make any changes for 2014. If you like you can keep the plan for as long as it’s offered.
Grandfathered plans must provide a yearly notice stating that the plan is grandfathered. As with other plans, insurance companies can change or cancel grandfathered plans at the end of the contract period.