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 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.
Yes, you can make changes to the coverage of ACA insurance policy in Texas.
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.
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:
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:
Such changes may be done at any time by speaking to:
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:
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:
There are three ways you can make changes to your ACA insurance:
Note: The assistance of a health insurance agent in Texas does not cost the insured extra.
If reporting life changes, you may do it:
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.
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.
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.
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.