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- Most consumers will need to change insurance plans when moving to a new state
- If you are moving outside of the Open Enrollment Period, for private and marketplace-based plans, you must apply for a Special Enrollment Period (SEP)
- The state you are moving to will determine whether you are eligible for Medicaid
- Medicare Parts A and B will not require special attention when moving to a new state
- Medicare Advantage and Part D plans may require new applications for coverage in a new state.
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Moving to a new state can be complicated and stressful enough without worrying about a lapse in health coverage. Unfortunately, it’s often the case that moving to another state will require you to invest some time in switching health plans. How you go about switching plans will depend on how you previously accessed coverage and how insurance provision is handled in the state to which you are moving.
Read on to learn about some obstacles you may encounter when trying to purchase insurance in a new state and some easy strategies to overcome those obstacles. With help, the transition can be seamless and simple.
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The Federal Marketplace
If you are currently enrolled in a plan through Health Insurance Marketplace, acquiring a new plan in a new state is relatively painless. Similarly, the Marketplace might be a good option for you if you have not yet secured employment in your new state but need health insurance right away.
One positive aspect of obtaining coverage this way is that many private plans are presented to you for comparison, and you can choose the plan that best suits your budget, desired level of coverage and needs.
The first step to accessing coverage is to apply for the Special Enrollment Period (SEP). Usually, individuals can only sign up for Marketplace plans during the Open Enrollment Period at the end of the year. However, exceptions to this rule are made to accommodate extenuating circumstances, one of which is moving to a new state.
If you are already a Marketplace consumer, follow these instructions to apply for SEP:
- Visit www.healthcare.gov.
- Sign into your existing Marketplace account.
- Select “Report a life change” from the options menu.
- Follow the prompts and answer questions provided to apply for SEP.
If you do not yet have a Marketplace account, the process is slightly different.
- Visit www.healthcare.gov.
- Select “See if you can enroll” from the front page.
- Enter your zip code and any questions that follow to see if you qualify for the SEP.
- Follow the prompts and answer questions provided to apply for SEP.
Once you qualify for the SEP, you can fill out an application for coverage for the current year. You may be required to attach scanned documents to prove your income or change of address. This is perfectly normal and will cause you to experience a lapse in coverage. Typically, coverage will begin pending the approval of these documents, so no need to fear.
Alternatively, you can call the Health Insurance Marketplace service number at 1-800-318-2596. A customer service expert can guide you through the process over the phone. This is a good option for people who are not comfortable using the online tool or who have questions or complications accessing coverage.
Please note that if you were uninsured prior to your move to a new state, you cannot qualify for the SEP. Rather, you will have to wait for the open enrollment period to sign up for health coverage for the following year. Alternatively, you could purchase a plan directly from a private insurer.
Purchasing a Private Health Insurance Plan
A few options are available for previously uninsured individuals who wish to obtain insurance coverage in a new state. It is important to compare these plans’ costs, benefits and terms to ensure the coverage meets your expectations and your needs. Among the options for private coverage are:
- Private Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) not available through the Marketplace
- Fee-for-Service-Plans, which compensate providers on a case-by-case basis
- Temporary health insurance plans, which last for less than a full year to tide you over until the next open enrollment period
- Disease-specific policies (e.g. cancer policies), which often do not meet the Minimum Essential Coverage requirements
The easiest way to navigate these private insurance plans is to hire an insurance broker or utilize a website that facilitates comparison. These websites and experts can also help you determine whether a plan meets requirements for Minimum Essential Coverage, thus satisfying the individual mandate clause of the Affordable Care Act.
Employer-Based Coverage
For individuals who access health insurance through their employers, the process may be a little different. Some larger employers offer multi-state plans that do not require any action on the part of the consumer. If you are lucky enough to be enrolled in one of these multi-state plans, congratulations. You already have health insurance in your new state.
If, on the other hand, if you are leaving your former employer-based plan for a new one, you may be required to take a few additional steps. Some employer-sponsored health insurance plans allow you to sign up immediately once you are hired.Others may have an open enrollment period during which employees can sign up for coverage.
Like the Marketplace, certain circumstances can trigger a special enrollment period during which a new employee may be able to sign up.
Your new human resources department should be able to explain the details of your new employer-sponsored plan. If your workplace lacks a human resource department, your boss should be able to put you in touch with an agent to help you navigate your employer-sponsored options.
If there is no open enrollment or special enrollment period available to you, you may have the option to remain a subscriber to your previous employer-sponsored plan through a program called COBRA. Employees and their families eligible for COBRA have experienced a “qualifying event,” such as:
- Death of the employee
- Termination or resignation
- Divorce from the covered employee
- A child aging out of coverage under his or her parents’ plan
Cobra coverage typically lasts 18 months, which is long enough to apply for coverage during your new employer-sponsored plans or the Marketplace’s open enrollment period.
Medicaid and Medicare
The passage of the Affordable Care Act offered monetary incentives for states to expand Medicaid coverage by raising the maximum qualifying income. Unfortunately, some states elected not to expand Medicaid. This is problematic for individuals who were previously covered by Medicaid, but moving to a state without expanded Medicaid. If this describes your present situation, you have two options:
- Sign up for a Marketplace plan with a subsidized premium. Unfortunately, these subsidies are not always extended to individuals making less than the federal poverty line. If this is the case for you, you may need to
- File for an exemption from the individual mandate based on financial hardship
You can assess whether your income qualifies you for a subsidized premium on www.HealthCare.gov. If you do not qualify for a subsidized premium, the Marketplace will provide you the option to file for an exemption. You will likely have to provide income and tax information to complete this step, which will exempt you from having to pay the penalty for non-compliance with the Affordable Care Act.
Unlike Medicaid, Medicare coverage (Part A and Part B) is not affected by a move to a new state. For Medicare Part D or Medicare Advantage plans, you may need to re-enroll in a new plan. As with other forms of coverage, your move will make you eligible for a SEP, during which you can enroll in new plans.
Equipped with knowledge and a good plan, you should be able to avoid a lapse in coverage when moving to a new state. If you are moving outside of open enrollment, knowing whether you qualify for a SEP is your first step regardless of your situation.
Early action, the help of an insurance agent or using a comparison website is always your next step. Insurance is complex, especially when moving states, so do not hesitate to ask an expert for help lining up coverage during this life change.
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