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.

Additional option if your plan is cancelled: A catastrophic plan

If your plan has been cancelled and you can’t afford a Marketplace plan to replace it, you can apply for a hardship exemption. This will allow you to buy a catastrophic plan.

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 insurance company 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 annually until 2016.

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.

Insurance companies can’t sell these plans to new customers. They can only renew the plans for existing customers.

If your plan offers you the chance to renew

If your plan insurance company 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 you can’t get lower costs based on your income 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.

You have all of these options any time of year, not just during Open Enrollment. When your plan ends you qualify for a special enrollment period. This lets you renew, buy, or change plans.

You may be able to renew through the plan year starting in 2016

If you decide to renew your coverage without the new rights and protections, you may be able to renew it annually through the plan year starting on or before October 1, 2016. This will depend on whether your insurance company continues to offer it.

If your insurer offers to renew your coverage, the price may change.