Changes in your job, income, household, or address can affect your health insurance options. If you have individual health coverage through the Health Insurance Marketplace, it’s important to understand when you may need to update your application, provide additional documentation, or take action to keep your coverage in place.
For employers and HR teams, these same questions often come up when an employee loses employer-sponsored coverage, retires early, or experiences another change that affects their benefits.
M3 Elevate can help individuals understand their options and navigate the individual health insurance marketplace.
What should I do when my circumstances change?
If your income, household, address, job, or access to other health coverage changes, update your Marketplace application promptly. The change may affect your eligibility, plan options, or financial assistance. Review the new eligibility notice, complete every required enrollment step, and confirm that your first premium has been received by the insurance carrier.
Depending on your situation, you may need to:
- Update your Marketplace application
- Review new eligibility results
- Submit supporting documents
- Complete enrollment steps
- Pay your insurance carrier
- Confirm when your coverage begins
If you aren’t sure how a change affects your coverage, an individual health advisor can help you understand your next steps.
Who may need individual health insurance?
Individual health coverage can provide an option when traditional employer-sponsored insurance isn’t available or doesn’t fit your situation.
You may explore an individual health plan if you are:
- Retiring before becoming eligible for Medicare
- Preparing for a gap between jobs
- Working as an independent contractor or 1099 worker
- Losing access to employer-sponsored health insurance
- Navigating another change in your health coverage
M3’s individual health materials specifically identify early retirement, employment gaps, and 1099 employment as situations in which someone may explore an individual health plan.
For employers and HR teams
Health insurance questions don’t necessarily end when an employee leaves your benefits plan. Employees experiencing a job transition may need to understand what coverage options are available to them next.
Connecting employees with individual health resources can provide another source of guidance as they evaluate their options.
What changes should I report to the Health Insurance Marketplace?
If you’re already enrolled in a Marketplace plan, changes to your circumstances may affect the coverage or financial assistance you’re eligible to receive.
According to HealthCare.gov, changes can include:
- Higher or lower household income
- Adding or losing household members
- Changes to your address
- An offer of other health coverage
HealthCare.gov recommends updating your application as soon as possible when your income or household changes.
Some changes require a different action. For example, becoming eligible for certain other health coverage may mean you need to end your Marketplace plan rather than simply update it.
How do I update my Marketplace application after a life change?
You can report a change by updating your Marketplace application.
If any of these life events apply, report changes to the Marketplace by updating your application online, by phone, or in-person. Follow the steps below to ensure your application is updated correctly.
- Log in to your HealthCare.gov account
- Choose the application you would like to update
- Click “Report a Life Change” on the left-hand menu
- Read through the variety of life changes that apply, and click “Report a Life Change” to get started
- Select the life change you want to report on the application
- Navigate through the application and report changes to income, household members, address, new health coverage offers, and additional information
- After you make adjustments to your application, you’ll get new eligibility results explaining your options to change plans
Applications can also be updated by phone or with in-person assistance. HealthCare.gov notes that changes can’t be submitted by mail.
What if I’ve moved?
The process can differ depending on where you’ve moved. If you’ve moved within the same state, follow the Marketplace’s instructions for updating your address. If you’ve moved to another state, HealthCare.gov currently instructs consumers to start a new application.
Because Marketplace processes and requirements can change, use HealthCare.gov as the source for current instructions.
Could a life change qualify me for a Special Enrollment Period?
Possibly. A Special Enrollment Period may allow someone who qualifies to enroll in Marketplace coverage or change plans outside the annual Open Enrollment Period.
Centers for Medicare & Medicaid Services states that reporting certain life changes can result in a new Marketplace Eligibility Notice explaining whether you’re eligible for a Special Enrollment Period.
Related Resource: Learn which life events may qualify you for a Special Enrollment Period for individual health insurance and what happens next. Learn More.
Why might the Marketplace ask me for documents?
After you apply or update your information, the Marketplace may ask for documentation to verify information in your application. The Marketplace may request additional documentation to confirm income, citizenship, immigration status, Special Enrollment Period eligibility, moved locations, or lost health coverage.
Follow the instructions in your Marketplace notice for the documents required in your specific situation.
How do I pay my first health insurance premium?
Your Marketplace application and your insurance premium are two different parts of completing enrollment. For Marketplace insurance, the premium is paid to the insurance company, rather than to the Health Insurance Marketplace.
Follow the payment instructions provided by your insurance carrier and confirm that your payment has been received.
The individual health insurance marketplace can be complicated, particularly when you’re already dealing with a job or life transition.
M3 Elevate helps individuals work through available Marketplace choices and understand the decisions involved. Talk with an M3 individual health advisor about individual health insurance options and next steps.
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