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Making Changes to Affordable Care Act Health Insurance in Texas

Making changes to your ACA insurance is a bit different from making changes to other Texas health insurance plans. The main difference is with regards to the time, during which you can make changes to your ACA insurance. You can only make changes to your ACA insurance during an open enrollment period. This is a time at the end of the year when you can select, re-enroll, or make changes to your health plan. Otherwise, you must have experienced a life event to qualify for a change of ACA insurance during the special enrollment period. An example of a qualifying life event could be: health coverage loss, relocation to another state, marriage, childbirth, or child adoption.

If you are eligible to change plans during a Special Enrollment Period, you have restricted options of metal plan categories to choose from. You can only choose a new plan within the same plan category as your existing plan or wait until the next Open Enrollment Period to change to an entirely new plan category.

However, you may be able to change your plan category under the following circumstances:

  • If you qualify for cost-sharing reductions and you do not have a silver plan, you can select a silver plan to use your cost-sharing reductions.
  • You have new household members through marriage, birth, adoption, foster care, or court order.
  • When your present plan does not permit you to add new household members to it, your family can enroll together for another plan in the same category. If there are no available plans in that category, they can enroll for a plan in another category.
  • If your employer offers to help with the cost of coverage for a Health Reimbursement Arrangement (HRA) or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA)
  • Special Enrollment Periods for complicated circumstances, such as misrepresentation or plan display error, gaining or maintaining status as a member of a federally recognized tribe.

If you want to make changes to Texas health insurance, discuss your options with a state-licensed insurance professional who deals in all types of health coverages. A health insurance agent evaluates your current medical, family and financial needs, and suggests how the existing policy may be modified, to suit your current circumstances better. In some cases the client may want more coverage, while in the others, cost may be more of an issue.

Can I Make Changes to the Coverage of ACA Insurance Policy?

Yes, you can make changes to the coverage of ACA insurance policy in Texas.

You can make changes during the Open Enrollment period, or if you experience a qualifying life event (QLE), during the Special Enrollment period.

A qualifying life event is an event that alters your life and/or the composition of your family to a degree that may necessitate a change in health insurance coverage. A common example of a QLE is marriage, the birth of a child, or loss/gain of employment.

What Can Be Changed in ACA Insurance?

ACA insurance allows you to change coverage during the Open or Special enrollment periods (based on qualification).

The insured is given an ability to modify coverages, by going between the metal tiers and their underlying insurance plans.

Metal tiers of ACA insurance determine the share of cost that the insured is willing to pay, until the maximum out-of-pocket amount is reached.

Each metal tier offers dozens, if not hundreds of possible plans (depending on the county's health marketplace). All the plans offered within a metal tier further differ in how the coverage functions, until you reach the annual maximum out-of-pocket amount:

  • Monthly premium
  • Deductible
  • Co-pay
  • Co-insurance
  • Maximum annual out-of-pocket amount

Maximum out-of-pocket amount (MOOP) is considered a defining factor between the ACA plans. MOOP + Premium = the total annual financial exposure for health care, in the worst case scenario.

If you have any questions regarding how the change may affect you - contact a state-licensed insurance professional, who can go over your scenarios, before you lock yourself in a plan for a year.

Additionally, you should promptly report any significant changes that may affect your eligibility or cost of ACA insurance. Such as:

  1. Annual income estimate
  2. Health coverage availability
  3. Household composition
  4. Correction of erroneous information
  5. Update of a federal and/or state-recognized status

Such changes may be done at any time by speaking to:

  • Your insurance agent - who can help with relaying this information to the insurer,
  • Logging into the ACA marketplace account - to process the changes yourself,
  • Contacting the insurer's customer service according to the terms of the policy

Changes to your estimated annual income must be promptly reported, in order to adjust the subsidies and tax credits accordingly.

Health coverage availability changes, such as if a member of your household gets:

Note: When a household member gets employer-provided insurance, you should cancel your Marketplace plan and expect a refund check in the mail.

Changes to your household or its members includes:

  • Childbirth
  • Adoption of a child
  • Putting a child up for adoption or foster care
  • Becoming pregnant
  • Getting married or divorced
  • A child in your household turning 26 years old
  • Death
  • Gaining or losing a dependent in another way
  • Changing a permanent address in Texas

Note: If you move out of Texas, do not update your ACA application. Instead, submit a new application according to your new state of residence's rules.

Addressing mistakes or changes to name, date of birth, or Social Security number of any one of your household members.
Status changes, such as:

  • Disability status
  • Tax filing status
  • Citizenship or immigration status
  • Change in status as an American Indian/Alaska Native or tribal member
  • Imprisonment or recent release from jail.

How Can I Make Changes to an Active ACA Insurance Policy?

There are three ways you can make changes to your ACA insurance:

  • By contacting the Human Resources employee benefits department of your employer (for group health insurance)
  • By contacting the Texas health marketplace and/or your insurer directly (if ACA plan was purchased on the individual marketplace)
  • By engaging a state-licensed insurance professional for help.

Note: The assistance of a health insurance agent in Texas does not cost the insured extra.

If reporting life changes, you may do it:

  1. Online: Log into your Marketplace account. Select your active application from the list of "Your Existing Applications." From the left-hand menu, choose "Report a Life Change." To begin, go through the list of changes and click "Report a Life Change." Choose the type of change you want to report. Report your change by browsing through the application. These include changes to your address, household members, income; new health coverage offers; and any other information. If your new eligibility results indicate that you are eligible for a Special Enrollment Period, you can look for and sign up for a different plan. Complete all of the tasks on your online to-do list. You may be able to enter your tax credit amount or answer questions regarding enrollment choices depending on your eligibility.
  2. Phone: Call the Marketplace Call Center at (800) 318-2596 and inform the representative of what you want changed. Follow further instructions provided based on your case.
  3. Health insurance agent: Make changes by consulting with your health insurance agent, who assisted you during the purchase of the policy. The agent continues to work as your conduit to the insurer even after the purchase and can give you advice on the repercussions of the intended changes.

There is a different approach to making changes if you move to a new state. If you leave Texas, you have to make a new application for an ACA plan. The process for this application depends on if your new state of residence operates its Exchange/Marketplace website or uses HealthCare.gov.

Can I Change Coverage Amount After Paying for ACA Insurance Policy?

Yes. You can change your coverage amount after paying for the ACA insurance policy, but only during certain times.

Regardless if you purchased ACA health insurance through an employer or on an individual marketplace, the coverage amount in ACA health insurance is determined by the metallevel of the plan and its features, such as a deductible, co-pay, co-insurance, and maximum out-of-pocket (MOOP) amount. The coverage can be changed during the Open Enrollment period by anyone, and by those who qualify - during the Special Enrollment period too.

Can I Add People to ACA Insurance?

You can add new household members to your ACA health insurance if your plan permits it. Usually you must prove that the additional person is an immediate relative and/or a dependent with an insurable interest.

Additions can be done during the Open Enrollment and, if qualified, during the Special Enrollment periods.

With employer-sponsored ACA insurance, contact your insurer during the authorized period or discuss your insurance options with your company's Human Resources representative.

With a Marketplace plan, log into your household marketplace account and report a life change in your household under your existing applications.

Always discuss the desired changes with an insurance professional. The new additional covered person may significantly affect your overall plan needs. An insurance professional can suggest if the current health insurance plan can be adjusted or you may benefit from an altogether different plan.

If your plan does not allow you to add new household members, your household members can buy a new plan together within the same metal category as you. If there are no available plans in that category, they can buy the health plan of another metal category.

Can I Remove People from ACA Insurance?

Yes. You can remove people from ACA insurance. If you are in charge of the household account, you can remove a deceased member or your child over 26 years old. To remove a member of your household, log into your Marketplace account. Under your existing application, report a life change in your household and update the information.

With an employer-offered ACA plan, discuss the issue directly with an insurer or your employer's HR.

There are very few things that can be changed in your ACA insurance without your consent. For example, suppose your coverage terminates at the end of the year because your insurer exits the market in your area. In that case, the marketplace will pick a new plan for you if you do not select one yourself during open enrollment. However, the coverage will not begin until you pay premiums. So, in the end, your consent is still required.