How often should I really be changing my health plan?

One of the biggest problems with the ACA Marketplace is that you can’t change your plan whenever you want.  It make sense why you can’t.  If people were allowed to make changes whenever they felt like it, they system would collapse because no one would have insurance until they absolutely needed it.  Then they would get rid of it again.

Putting that aside, every year our lives change, and we should be making sure that our health coverage changes with us.  Now, short of an SEP, we only have one chance a year to make this change.  This goes for people on Medicare Advantage Part C plans and those with a Medicare Part D plan as well.  Come fall, you need to be taking a minute and review a few things to make sure you are in a good spot for the upcoming year.

So is it that we should be reviewing?  How does the process of changing a plan work?  

What about your current plan isn't working for you?

If you could change anything about your health coverage currently, what would it be?  Lower deductibles?  Maybe less coinsurance and more copays so that you can better budget?  Are you happy with the network?  What about the prescription drug coverage?

How is the price?  Are you still okay paying that amount for another year?

How has your health changed in the past year?

What has changed about you in the past year?  Did you have any surgeries?  How did your plan handle those?  What medication were you required to take?  Did you need to get prior authorization?   Maybe you have started embracing preventative care, is your current plan geared towards that?

Have you needed to see any additional doctors?

Any new specialist?  Are they all in network?  Are you happy with your PCP?  What about the hospital you go to, is that working ok for you?

Financially, are you in the same place as last year?

It is important to keep on top of your income with the Marketplace so that you aren’t needing to reconcile at the end of the year.  Are you receiving any CSR or APTC?  With those being income based, make sure you are updating your account every so often (3-4 times a year should be fine) to re-determine your eligibility.

Every year, your insurance company send you a letter.

This letter contains any and all changes that may be happening to your plan for the next year.  It is important that you read through this and understand the changes.  One of the benefits of working with us is that as your agent of record, we can sort through all of this for you and let you know of the change that are happening.  Even if you chose not to work with us, make sure the company you go with is doing this for you.

What's the process for changing coverage?

Review.  You’ll get your letter from your insurance company.  Go through the questions listed about and make sure you understand what changes will be affecting you.

Update your information by logging into the federal Marketplace starting November 1 and update your current year application.  Make sure that you household income and other information is up-to-date.

Compare your current plan with what is available in your area.

Choose the health coverage that best fits your budget and needs.  Make sure hospitals and doctors are in in-network.  Make sure current medications are covered.  Understand any deductibles and other cost-shares.  Understand any prior authorization you will need.  Look and and download your summary of benefits and coverage.

Enroll in a plan.  Make sure to pay your first month’s premium by December 15th for coverage to start on January 1 if you are changing plans.  If you are keeping the same plan, just keep making payments like you have been.

What happens if my current plan is ending?

This rarely happens, but it is a possibility.  If you have an ACA plan, you will receive a letter from your insurance company letting you know that your plan is  going to end.  If you decide on your own to enroll in a new plan, you’ll be good to go and can stop reading here. 

If you don’t do anything though, CMS will automatically enroll you in a new plan of their choosing.  You will need to pay the first month’s premium to make you plan effective, which is critical to not lose coverage.

You will receive two notices at this point.  One from CMS letting you know about your plan change and another from your new insurance company letting you know about the change.

You will have a SEP to enroll in a new plan moving forward, but don’t wait too long or you’ll be stuck with the plan for the remainder of the year.

If you do not have an ACA plan and your current coverage is ending at the end of the year, you will still receive a notice from your insurance company, but you will not automatically be enrolled in a new plan.

If this is your situation, it is imperative that you find a new plan quickly as lapsing coverage for an extended period of time can result in an inability to get new coverage.


No matter your plan, your insurance company will send you information regarding all of your changes.  Comparing your options only takes a few minutes, and nothing is worse than being stuck for the next year.  Give us a call and we can help you review your option to make sure you’re set up for the next year.


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