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 due to a change in eligibility for Affordable Care Act subsidies. However, if you are enrolled in a marketplace plan, your income changed, and you now earn more than 250 percent of the federal poverty level (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