How do I renew or change my Marketplace plan?
Doing nothing renews you automatically, which is rarely the right outcome. Here is what to check every November.
If you take no action during open enrollment, the Marketplace generally re enrolls you automatically, either in your current plan or a similar one if yours is discontinued.
That sounds convenient and it is usually the wrong outcome. Three things change every January and auto renewal accounts for none of them.
What changes underneath you
- Your plan's premium, deductible and out of pocket maximum are reset for the new year.
- The benchmark plan in your area can change, which changes your premium tax credit even if your income did not change at all.
- Networks and drug formularies are redrawn. Your doctor can be out and your medication can move tiers.
The second one catches the most people. Your subsidy is tied to the second lowest cost silver plan in your area. If a cheaper silver plan enters the market, the benchmark drops, your credit drops, and your monthly payment rises even though nothing about you changed.
What to do every November
- Open the notice from your insurer and the notice from the Marketplace. Both arrive in the fall and both matter.
- Update your income estimate for the coming year. This is the step people skip and it is the one that causes tax surprises.
- Update household changes: marriage, divorce, a birth, a child aging off, someone gaining employer coverage.
- Re shop. Log in and compare your renewed plan against everything else available, with your doctors and medications entered.
- Check whether you now qualify for cost sharing reductions. If you do, a silver plan is usually the right answer.
- Enroll by the deadline. December 15 is typically the cutoff for January 1 coverage, with open enrollment running through January 15 for later start dates.
Changing plans mid year
Outside open enrollment you need a qualifying life event. Moving, marriage, a birth, losing other coverage, or a change in income that affects your eligibility. See the full list.
Being unhappy with your plan is not a qualifying event, which is the argument for taking the November review seriously.
If your plan is discontinued
You will get a notice. The Marketplace will usually map you to a similar plan from the same insurer, but similar is doing a lot of work in that sentence. Treat a discontinuation notice as a prompt to shop properly rather than accept the mapping.
Keep the paperwork
Form 1095-A arrives in January and you need it to file and reconcile your credit. If you changed plans mid year you may get more than one. See how reconciliation works and the application process.
Common follow-up questions
What happens if I do nothing?
You are generally auto re enrolled. Your costs can change substantially and your doctors may no longer be in network.
Why did my premium go up when my income did not change?
Usually the benchmark plan in your area changed, which changes your credit. It is the most common cause and it has nothing to do with you.
When is the deadline?
Open enrollment runs November 1 to January 15. Enroll by roughly December 15 for coverage starting January 1.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. No cost to talk it through.
Call (956) 687-3334Read next
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