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. In general no, although it might be possible depending on the circumstances.

If you experience a qualifying event that triggers a special enrollment period (SEP), you may be able to switch to a different plan. But a need for medical care is never a qualifying event, and rules that HHS finalized in 2017 limit the ability to switch to a plan at a different metal level outside of open enrollment.

Plan changes are only possible during open enrollment and special enrollment periods triggered by a qualifying event. These rules apply both on and off-exchange. So regardless of whether you buy your health insurance plan through the exchange/Marketplace or outside the exchange, you won't have an opportunity to switch to a different plan until the following year (during open enrollment) unless you experience a qualifying event.

And the rules that mostly limit people to plan changes within the same metal level apply to most SEP plan changes. There are some circumstances in which a SEP can be used to switch to a plan at a different metal level, including a person becoming newly eligible for cost-sharing reductions (only available with Silver-level plans) or adding a new family member to the household.¹ But in general, plan changes made during a SEP are limited to other plans at the same metal level you already have.

Open enrollment runs from November 1 to January 15 in most states, and allows you to switch to any plan you like, at any metal level. But once open enrollment closes, your ability to switch to a different plan later in the year is sharply limited.