QUESTION

I currently have a bronze-level marketplace plan, and am eligible for a special enrollment period. Can I change into a silver-level plan?

Individuals with coverage | Individual and Marketplace Health Coverage
ANSWER

In general, you can only change into a health plan in the same metal level as your current plan under special enrollment periods. However, if you have an income or household change making you eligible for cost-sharing reductions, you may change into a silver plan. There are a few other exceptions to the plan limitation under special enrollments. If you qualify for a SEP due to marketplace or marketplace-related entity error, misrepresentation, inaction or misconduct; domestic abuse or spousal abandonment; or an exceptional circumstance, you have the option to enroll into a health plan at any metal level. Additionally, if there are no plans available in your current metal level, you may choose a product in an adjacent metal level (i.e., if you’re enrolled in a silver plan, you are permitted to switch to a bronze- or gold-level plan, but not platinum). There are also exceptions for those using a special enrollment period to enroll new household members – in this case, the new household members, not the current enrollee, may enroll in any metal level (and, if the enrollee’s current plan does not allow them to add the new household members, the entire family can enroll in an adjacent metal level to the enrollee’s current metal level). The limitation on plan selection under a special enrollment also does not apply to American Indians or Alaska Natives. (45 C.F.R. § 155.420; 82 Fed. Reg. 18346, April 18, 2017).

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