Making Changes to Your Health Insurance? Read This First

Life is all about changes — to your diet, to your home, and, yes, even to your health insurance. For instance, you might be changing health insurance plans because the one you have isn’t the one you need.

It’s important to re-evaluate your health insurance needs periodically, not only to make sure you’re completely covered but to ensure that you’re on the right plan for you. And even if it’s not high on your to-do list, it’s important to revisit all the details in your plan — don’t just assume that everything’s in order.

If you’re changing health insurance plans or providers this year, here are some things to consider.

Where to Get Health Insurance

Most people have health insurance plans through one of these options:

  • Plans offered by employers
  • Plans offered by the federal health insurance Marketplace
  • Individual plans bought outside the Marketplace
  • Medicare
  • Medicaid
  • The Children’s Health Insurance Program

Sometimes you need a new health care plan when:

  • Your health insurance carrier doesn’t offer coverage in your area anymore
  • Your premiums or prescription plan costs rise substantially
  • Your prescriptions are no longer covered by your plan
  • Your primary care provider no longer accepts your insurance
  • You’ve lost your job or been laid off
  • Your children have turned 26, are no longer on your health insurance plan and now you want to explore your options
  • You’ve just turned 26, and are no longer covered by your parents’ insurance
  • You just want to make a change

To the Marketplace

In 2017, Congress eliminated the penalty associated with failing to comply with the mandate of the Affordable Care Act. Meaning come 2019, you’ll no longer be required by the federal government to have health insurance. The state you live in, though, might still require you to carry health insurance; check here to see if you live in one of those states. (Massachusetts has had an individual mandate since 2006, and it remains in effect.)

If you do live in a state with an individual health insurance mandate, you and millions of others have access to health insurance plans thanks to the Marketplace established by the Affordable Care Act. The Centers for Medicare and Medicaid Services says more than 12 million people used the Marketplace last year to purchase a health care plan.

The next open enrollment period begins Nov. 1. The federal government says that to be eligible for enrollment through the Marketplace, you:

  • Must live in the United States
  • Must be a U.S. citizen or national (or be lawfully present)
  • Can’t be incarcerated

Additionally, people who have Medicare coverage cannot purchase health insurance through the Marketplace.

Although the federal government’s website is very comprehensive, purchasing health insurance is nonetheless a complicated procedure. There’s no shame in asking for help, and there are certified agents in your area who can help you change health insurance plans or find your state’s Marketplace. Remember: The Marketplace is only for purchasing health insurance; other types of insurance, such as long-term care or auto insurance, must be bought elsewhere.

You can also purchase new health insurance with the help of an agent, independently through a health insurance company, or from a website that can provide you quotes from a variety of health insurance providers.

Save These Dates

With open enrollment right around the corner, it’s important to keep some important dates in mind:

  • The open enrollment period runs Nov. 1 through Dec. 15, 2018.
  • You must choose a plan by Dec. 15 or you’ll have to try to get coverage for next year during the special enrollment period. You can only qualify special enrollment if you’ve experienced certain life events — maybe you’ve lost your health coverage, or you’ve moved, gotten married, or had or adopted a child.
  • If you purchase a plan during the open enrollment period, your coverage starts Jan. 1, 2019.

Even if you decide to keep your 2018 plan, the government will require you to update your expected 2019 income along with your household information, because those will determine how much of your Marketplace plan will be subsidized. Look for two letters in your mailbox: one from your present health insurance carrier and another from the Marketplace. You’ll learn your status and the name of your plan — though both are subject to change if you make changes to your plan before Dec. 15.

Although changing health insurance may take some time, be glad you have choices when you’re shopping around. The current laws stipulate that companies can’t deny you coverage or raise your rates if you have a pre-existing condition. So take the time to really assess where you are right now and find a plan that matches your needs as closely as possible.

The perfect plan is out there; don’t hesitate to ask for help if you need it. Your health is worth it.


*The content on this website is for informational purposes only and is not medical advice. Please consult a physician regarding your specific medical condition, diagnosis and/or treatment.

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