Can I Change My Family Health Plan Mid-Year? Here’s What You Need to Know

Life is unpredictable, and so are the needs of your family. As you navigate the world of health insurance plans for families, you may wonder: Can I change my plan in the middle of the year? The answer is yes, but only under certain circumstances. Understanding when and how you can make changes is crucial for keeping your family protected and your finances in check.

The Basics: Open Enrollment vs. Mid-Year Changes

Every year, there’s a designated Open Enrollment Period for health insurance plans. In California, the Open Enrollment for 2025 runs from November 1, 2024, to January 31, 2025. During this window, you can:

• Enroll in a new health insurance plan for your family
• Switch between plans
• Add or remove family members from your coverage

Outside of this period, you generally cannot make changes, unless you qualify for a Special Enrollment Period (SEP).

What Is a Special Enrollment Period (SEP)?

A Special Enrollment Period allows you to make changes to your health insurance plan mid-year if you experience a qualifying life event. These are major changes in your life or household that impact your insurance needs. Examples include:

• Marriage or divorce
• Birth, adoption, or placement of a child
• Loss of other health coverage (e.g., job loss)
• Moving to a new area with different health plan options
• Other significant changes, such as a death in the family or gaining lawful presence in the U.S.

When you experience a qualifying event, you typically have 60 days from the date of the event to enroll in a new plan or make changes to your current coverage.

Why Are These Rules in Place?

These rules are designed to keep the insurance marketplace stable and prevent people from enrolling only when they need expensive care. By limiting changes to certain periods or events, insurers can better manage risk and keep premiums more predictable for everyone.

How Do I Report a Qualifying Life Event?

If you experience a qualifying life event, you must report it to your insurance provider or through Covered California as soon as possible. Here’s what you need to do:

1. Gather Documentation: Proof of the event, such as a marriage certificate or birth certificate.
2. Contact Your Marketplace or Insurer: Visit Covered California’s qualifying life events page for a full list and instructions.
3. Submit Your Application: You’ll have 60 days to choose a new plan or update your existing one.

What If I Miss the Window?

If you don’t act within the 60-day SEP window, you’ll have to wait until the next Open Enrollment Period to make changes unless you experience another qualifying event.

Financial Help and Plan Options

California continues to expand financial support for families purchasing health insurance. In 2025, over a million Californians will benefit from enhanced cost-sharing reduction programs, which can eliminate deductibles and lower out-of-pocket costs for qualifying households.

Covered California offers plans from leading companies like Blue Shield, Anthem, Kaiser, Health Net, LA Care, and more, with some premiums as low as $1 per month for those who qualify.

For more guidance or to explore health insurance plans for families in California, contact us today at California Affordable. Protect your family’s health and finances by staying informed and ready to act when life changes. You can also call us directly at (800) 903-0326.

Key Takeaways

• You can change your family health insurance plan mid-year only if you have a qualifying life event.
• You have 60 days from the event to make changes.
• Outside of SEP, changes are only allowed during Open Enrollment.
• Financial help is available for many California families.

Read more: What Are the Mistakes to Avoid When Choosing a Health Insurance Plan?

Frequently Asked Questions (FAQs)

Q1: If I add a new family member mid-year, when does their coverage start?

Coverage for a new family member (such as a newborn or adopted child) typically starts on the date of birth or adoption, but you must notify your insurer and complete the enrollment within the SEP window.

Q2: Can I switch to a different insurance company during a Special Enrollment Period?

Yes, you can choose a new plan from any participating insurer in your area during your SEP, not just your current provider.

Q3: What happens if my income changes significantly mid-year?

A significant income change may qualify you for a SEP or alter your eligibility for subsidies. Report changes promptly to Covered California to adjust your plan and avoid owing money at tax time.

Q4: Do I need to provide proof of my qualifying life event?

Yes, documentation such as a marriage certificate, birth certificate, or proof of loss of coverage is required to validate your SEP eligibility.