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When Should I Consider Changing My Health Plan?

Vicky Warren · October 8, 2019 · 4 min read


Health insurance is one of those things you need but can be extremely difficult or confusing to understand. For many of us, we pick the most affordable coverage at the time and then move it to the back of our mind.

Did you know that many employer-based and marketplace health plans automatically re-enroll you each year for the health plan you currently have? While this is a good way to keep coverage, there are a few reasons to check-in annually to be sure you have the best plan for you and your family.

We’ve compiled a few key reasons as to why you should consider changing to a different healthcare plan.

Your current doctor stops accepting your current insurance plan.

Doctors change the health plans they accept from time to time. It’s vital to call your doctor to see if they are going to continue taking your insurance, whether you change plans or not. If your doctor stops accepting your plan, you have a couple of options:

  • Pay for out-of-network visits. Some of these visits may be partially paid for by your plan, but they won’t be covered in full.

  • Switch health insurance plans during open enrollment or if you have a Qualifying Life Event (or QLE)

Your costs for your current insurance plan dramatically increase.

Even if you stay in the same plan, it’s not guaranteed you’ll see the same expenses each year. Studies indicate some health plans saw as high as a 15% increase in 2019 over 2018 and the trends are likely to continue.

You can often find a similar plan and pay close to the same amount, but you’ll have to research to find the best deal.

Your health plan does not cover the prescriptions you need.

Health insurance companies can choose to no longer cover certain drugs or change how much they cover. Either way, many people have a good idea of their current medication costs, so a surprise expense at the pharmacy could cause unnecessary stress. Check with your insurance company to ensure they’ll cover your prescriptions next year, if not, consider switching to a plan that will.

When to Change Plans

Open enrollment happens each year. It’s when you can sign up for or change your health insurance plan. If you’re eligible and apply for health insurance during this period, the health plan you choose must insure you.

You can obtain health insurance through your state’s health insurance exchange or individual marketplace.

If you’re purchasing health insurance for yourself, there are several ways to buy a policy:

  • Purchase from your state's health insurance marketplace. Head to to get started.

  • Buy a plan from a health insurance company

  • Go to websites like eHealth and HealthMarkets which offer quotes from several carriers in one place

  • Purchase a health plan from an insurance agent

If you get health insurance through your work benefits, your employer will tell you when open enrollment is (it may not be the same as the federal open enrollment period).

Qualifying Life Events

If you miss the open enrollment window and want to change health plans, you’ll have to wait until next year unless you have a Qualifying Life Event (QLE).

A QLE is a change in your current situation, such as getting married, having a baby, adopting a child, or losing health coverage. These events can make you eligible for a Special Enrollment Period, known as a SEP, and will allow you to obtain or change coverage outside the open enrollment period.

There are four basic types of QLEs:

Household Change:

  • Marriage or divorce

  • Having a baby or adopting a child

  • Death in your family

Health Coverage Loss:

  • Losing current individual, student or employment-based coverage

  • Losing Medicare, Medicaid or CHIP eligibility

  • Losing coverage through parent plan at age 26

Residence Change

  • Moving to a different ZIP code or county

  • Moving to or from a place to attend school

  • Moving to or from a place for seasonal employment

Additional QLEs:

  • Income changes affecting your coverage options

  • Gaining membership into a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCS) Corporation shareholder

  • Becoming a U.S. citizen

  • Leaving jail or prison

  • Starting or leaving service as AmeriCorp member

The above is not an extensive list of QLEs, to find out if you are eligible for coverage due to a QLE, start here.

Open enrollment will be here soon. Now is the perfect time to look at your current health insurance and decide if it’s serving you well or if you need to make changes. That six-week enrollment window will go quick, so be prepared when November 1st (or your plans open enrollment start date) rolls around!

Vicky Warren

Vicky Warren

Vicky Warren, once a nurse, now a freelance healthcare writer and social media coach.

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Disclaimer: the content presented in this article are for informational purposes only, and is not, and must not be considered tax, investment, legal, accounting or financial planning advice, nor a recommendation as to a specific course of action. Investors should consult all available information, including fund prospectuses, and consult with appropriate tax, investment, accounting, legal, and accounting professionals, as appropriate, before making any investment or utilizing any financial planning strategy.



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