Health insurance plans which are compliant with the Affordable Care Act are intended to run from January 1st until December 31st without change. This rule is designed to make it impossible to change a plan in mid-year to cover additional risks or to avoid paying contracted premiums. There are supplementary plans and state or federal support to help meet these contingencies.
However, the ACA recognizes the need for plan changes in certain defined circumstances, a.k.a. Life Events which qualify you for a Special Enrollment Period (SEP) i.e. outside the period of Open Enrollment (November 1st_December 15th).
The events which qualify for health insurance under SEP can be divided into 3 categories.
Changes in residence
You move to another State, County or Zip Code (see below)
Loss of health insurance coverage
If you or anyone loses qualifying health coverage through no fault of their own you may qualify for a Special Enrollment Period.
(see our article lost health insurance qualify for special enrollment period),
Changes in houehold
Something happens to change the status of the individuals covered by your plan
(see our article qualify for special enrollment period 2020, changes in household).
Changes in residence
There are many things to think about when you move, not least to make sure that your health insurance is valid in your new location.
Even before you plan a household move you should take your healthcare needs into account. First, check that your insurer operates in your proposed new location, is your plan type (and metal level) available and are the facilities you need within your existing network?
The good news is that most changes of location open a window of opportunity which allows you to sign up for a new plan which matches your new requirements.
OF COURSE, we advise you to research your needs and local providers (consult your health exchange) before the move but you have the 60 days following your move in which to enroll in a new plan.
The following household moves qualify you for a Special Enrollment Period if you are moving: –
- To another State, County or Zip Code
- To the U.S. from a foreign country or from a United States Territory
- From a shelter or other transitional housing
If you are: –
- A student moving to or from where you attend school
- A seasonal worker moving to or from the place where you both live and work
Moving only for medical treatment or staying somewhere on vacation does NOT qualify for an SEP
You must confirm, and if required, prove, that you had qualifying health coverage for one or more days during the 60 days prior to your move. This is not necessary if you are moving from a foreign country or a U.S. territory.