QUESTION

I qualified for the cost-sharing reduction when I signed up for coverage in the marketplace. I’m getting more hours at work and might not qualify anymore. Will I have to change plans now with a new deductible and out-of-pocket cap?

Post enrollment issues | Individual Health Insurance
ANSWER

No one is forced to change plans. However, if your income changed and you now earn more than 250 percent of poverty (which is the income limit to qualify for cost-sharing reductions), you are entitled to a special enrollment period, but you can only enroll into a plan within the same metal level as your current marketplace plan. If your income no longer qualifies you for cost-sharing reductions, the insurer is required to change your plan to the correct standard silver plan or plan variation once your insurer is notified by the marketplace about such a change in eligibility. Because you’ll continue to be enrolled in a silver plan (but with different cost-sharing, appropriate to your income), then out-of-pocket costs already paid during that year must be counted against the out-of-pocket costs required under the new version of the plan. (45 C.F.R. § 155.420).

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Post enrollment issues