Can You Change Your Health Plan Under the Affordable Care Act (ACA)?

It's not easy to change coverage under Obamacare but it can be done.

You've enrolled in healthcare through your state health insurance exchange and already paid your first premium for the year. Congratulations! But what happens if you later decide you’re not happy with the plan you chose—for example, because it doesn’t include your old doctors, or has too high a deductible? Can you change your plan to something you like better?

Basic Rule

The Affordable Care Act (also known as Obamacare) is designed so that it is hard to change your coverage after it becomes effective. If you enroll by the 15th of the month, your coverage becomes effective by the 1st of the following month—for example, if you enroll on February 15, 2016, your plan becomes effective on March 1, 2016. If you enroll between the 16th and the last day of the month, your coverage becomes effective on the first day of the second month after that—for example, if you enroll on February 28, 2016, your coverage becomes effective April 1, 2016.

The general rule is that once your Obamacare coverage becomes effective, you can’t change it unless you have a “qualifying life event.” Qualifying life events include:

  • you got married, divorced, or legally separated
  • you gave birth to or adopted a child
  • you lost your coverage because you moved to another state or a part of the same state outside of your health plan service area, or
  • you enrolled through your state health insurance exchange and your income increased or decreased enough to change your eligibility for Obamacare subsidies.

Qualifying life events do not include deciding that you don’t like the coverage you’ve chosen, for whatever reason. Thus, if you don’t like your coverage, but don’t have a qualifying life event, you have to wait until the next open enrollment period to change your coverage for the following year.

Special Rule for 2014

The Obama Administration informed health insurers that it was enacting special rules for 2014 to help individuals who are dissatisfied with the plans they initially chose. Under the rules, consumers will be allowed to make changes to their plans if they want to “move to a plan with a more inclusive provider network” or fit within “other isolated circumstances” that have yet to be worked out. However, such changes must be made by March 31, 2014 when the open enrollment period for 2014 ends. In addition, people who change their plans must stay with their same insurer and level of coverage—bronze, silver, gold, or platinum.

There is another alternative available for consumers who want to switch insurers and have not yet made their first premium payments. They can get their insurers to cancel their coverage by refusing to make that initial payment. They can then go back to their state exchange and reapply for new coverage. However, this must be accomplished before the end of the 2014 open enrollment period—March 31, 2014.

Special State Rules

Depending on the state you live in, the rules may differ from those described above because states with their own health insurance exchanges have the ability to adopt their own rules--within limits. So, be sure to check with your state exchange if you might be interested in changing plans. For links to all 50 state exchanges, visit the website.

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