Revenue Cycle
and Billing

New Marketplace Policy: Plan Changes

by | Feb 13, 2019 | Uncategorized

Beginning in February 2019, the Health Insurance Marketplace started implementing a new policy when it comes to plan selections for clients with qualifying events that trigger a Special Enrollment Period (SEP). The new policy limits the circumstances that allow you to switch to a different plan category after qualifying for a SEP. For instance, if you are enrolled into a Silver plan in Tennessee, and you move to Georgia, you will only be allowed to enroll into a Silver level plan.  There are a few exceptions to this new rule:

  1. If you lose qualified coverage from outside the Marketplace, like from an employer, Medicaid, or CHIP, you can enroll into any plan level you would like. Any subsequent Special Enrollment Periods you may qualify for through the Marketplace would then require you to select a plan within the same plan level for the rest of the year.
  2. In the case of adding new household members, such as through marriage, adoption, or birth, you can choose to either add your new family member to your plan level, or they can be separated to a new group prior to plan selection and can enroll into any plan on their own.  For example, if a married couple is enrolled into a Bronze plan for 2019, and they have a child in June, they can choose to add the child to their Bronze plan. Alternately, they can choose to put their child into his own group, and enroll him by himself into a Silver, Gold, Platinum, or even a different Bronze plan than their own.
  3. If the plan you are enrolled in does not allow new household members to be added, your whole family can choose to enroll into a different plan in the same category level. If there are not other plans in that same metal level, then you can go one level up or down.  So, if your Gold plan doesn’t allow additions throughout the year, and it is the only Gold plan available in your zip code, then you will be allowed to move everyone in your family to either a Silver (one level down) or Platinum (one level up) plan.

For help determining if you qualify for an SEP and/or completing changes to your enrollment if needed,call American Exchange at 888-995-1674.  We are happy to help!