We know things change; it's life. But one thing's certain: Health insurance can help you smoothly navigate unforeseen events. Under the Affordable Care Act (ACA), most Americans must now have health insurance, or they will face a tax penalty. This tool is designed to help you better understand how life changes might impact your health insurance coverage. So, how do you navigate health insurance as your life changes?
Here are a few things to know that can help you stay on course.
Do you qualify for a change?
Marketplace, employer, private, and other types of insurance (such as Medicare Advantage) provide open enrollment once a year. If you don’t sign up for insurance during that time, you usually have to wait until the next open enrollment period. Certain life events, however, qualify you for a special open enrollment period typically 60 days from the date of the event.
It's important to report life changes to your health insurance provider right away. If you're insured by a Marketplace, changes could qualify you for greater or fewer premium tax credits; make adjustments as soon as possible to avoid any tax-time surprises. Your out-of-pocket cost and coverage option savings could change, too.
New Baby
Congratulations, your family is growing! If a child is born, adopted, or fostered into your family, you may qualify for different health coverage. With Marketplace coverage, these changes could affect your family’s eligibility for premium tax credits. If you’re currently without health care, Medicaid might be available to you or your baby, depending on your income. Under a private plan, you may need to talk to HR about adding your child to your health insurance plan.
Does your child need a pediatrician? On a new plan, more options may be available!
A growing family can affect your premium tax credit. Visit irs.gov to learn more.
If you place your child for adoption or foster care, you have a special enrollment period to enroll in coverage.
Marriage
If you marry or enter into a domestic partnership, you or your spouse/partner can use the special enrollment period to enroll or change coverage. These updates may change your eligible coverage or savings, so be sure to report your union right away.
Is coverage less expensive on your spouse's plan? You may use a special enrollment period to switch to your spouse's plan.
If you don’t currently hold insurance, you can enroll on the Marketplace.
Divorce
Beyond all the other legal paperwork required for a divorce, your eligible health care coverage or savings may change. If you are currently without health care, you may be able to register through the Marketplace, or Medicaid may be available to you depending on your income.
If you were covered under your spouse’s insurance, you may need to acquire your own. Remember: You typically have 60 days from finalizing a divorce to do this.
New Residence
If you’re moving across state boundaries, you may also need to make some changes to your current health care plan. Your eligible coverage or savings may change based on your new residence, so check with your new Marketplace or employer about obtaining coverage.
Does your employer know about your recent move? Talk to HR to see if you need to notify your health insurance provider.
A new job, lost job, or change in income may affect your eligible coverage or savings.
If you fall below a certain income threshold, you may be eligible for Medicaid.
Use our Income Estimator tool to help estimate your new yearly income for more accurate Marketplace premium tax credits.
26th Birthday
Happy birthday! Twenty-six is the new adult, making you ineligible for staying on your family’s plan from then on. Don’t forget to register for your own health insurance amidst all the festivities.
If you turn 26 and fall below a certain income threshold, you may be eligible for a Marketplace plan or Medicaid.
Selecting a health insurance plan for your lifestyle:
This may be the first time you’ve ever registered for your own insurance. If you rarely visit a doctor, pick a plan that fits your lifestyle, such as a high-deductible plan with lower premiums and higher out-of-pocket costs to decrease your monthly payment.
Gained Citizenship
Proud to be an American! If you become a citizen, national, or permanent legal resident of the United States, your coverage and savings eligibility may change.
If you become an American citizen and fall below a certain income threshold, you may be eligible for a Marketplace plan or Medicaid.
Reporting changes after a life event isn't difficult and may lead to new health insurance options and more savings. Remember, the ACA requires health care for most Americans, so be sure to report within the 60-day period and explore the options available to you.
These additional resources may help you through the process:
Disclaimer
This tool is designed to help you better understand the life changes that might be eligible for a special insurance enrollment period. For other applicable qualifying life events, go to HealthCare.gov's special enrollment period site or speak with your HR department. Your eligibility may vary based on your plan.
If you or a family member has private insurance, please contact your employer’s HR department or your health insurance carrier directly to understand your policy.
If you or a family member has insurance through the Marketplace, contact HealthCare.gov to understand your policy.
After you report changes, you’ll receive a new eligibility notice to explain whether you qualify for special enrollment and whether you’re eligible for lower costs based on your new information.
If you’re eligible for special enrollment, you’ll be able to shop for a different plan on the online Marketplace. Just log in to your account, select your application, select "Eligibility and Appeals" from the left-side menu, then scroll down and click the green button to"Continue to enrollment." You can also contact the Marketplace Call Center to change plans by phone.
If you’re not eligible for special enrollment but the tax credit you qualify for has changed, you cannot change plans but can choose to adjust the amount of the tax credit to apply to your monthly premiums.
