If I sign up for a Bronze plan during open enrollment, can I bump my coverage up to a higher level several months later if I find out that I need surgery?

Q: If I sign up for a Bronze plan during open enrollment, can I bump my coverage up to a higher level several months later if I find out that I need surgery?

A: No. After open enrollment ends, you won’t be able to change your policy until the next open enrollment period. A 60-day open enrollment window can also be triggered on an individual basis by a qualifying event, but a change in health status is not a qualifying event.

Open enrollment for 2018 coverage ended on December 15, 2017 in most states, although there are quite a few extensions and special enrollment periods, depending on where you live.

Open enrollment and special enrollment periods triggered by qualifying events apply both on and off-exchange (with the exception of Nevada, where off-exchange plans are available year-round, albeit with a waiting period). So regardless of whether you buy your plan through the exchange or outside the exchange, you won’t have an opportunity to switch to a different plan until the following year (via open enrollment) unless you experience a qualifying event.

And even with a qualifying event, new rules that HHS finalized in 2017 limit the ability to switch to a plan at a different metal level outside of open enrollment.

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Related terms

health insurance exchange

metal plans

open enrollment

qualifying event