Moving between counties or states

Marketplace plans are approved county by county. That single fact is why a move — even a short one — can change everything about your coverage, and why it opens an enrollment window.

When a move opens a window

A permanent move that gives you access to new plan options generally opens a sixty-day special enrollment period. That includes moving to a different county or a different state, moving to or from a place you attend school, and moving to or from seasonal work.

Two conditions worth knowing:

You usually need to have had coverage for part of the period before the move. There are exceptions, including moves from abroad and from certain other circumstances. If you were uninsured before moving, ask rather than assume.

A temporary move generally does not count. A holiday, or a stay for treatment, is not a change of residence.

Why a county line matters this much

Which plans exist, which carriers offer them, what the networks look like, and what the prices are, are all set at county level.

So a move of ten miles across a county line can mean:

• your current plan is not offered where you now live;
• your doctors are out of network, even though they have not moved;
• the plans that are available look completely different;
• your premium tax credit changes, because the benchmark used to calculate it is local.

Moving between the four states we work in — Kansas, Missouri, Nebraska and Iowa — changes more again, since Medicaid and CHIP rules differ by state.

What to do, in order

1. Note the date you actually move. The window is counted from it, and you will be asked for it.

2. Update your address with the Marketplace as soon as you can. You can generally report a move in advance, which is how you avoid a gap rather than backfilling one.

3. Re-run your doctors. New county, new networks. Check each clinician by name with the practice’s billing office, and check the hospital you would actually be taken to. In rural counties this decides the plan choice.

4. Re-run your medications. Formularies and preferred pharmacies differ by plan, and the pharmacy you will now use may not be the one you did.

5. Re-check your income estimate. A move often comes with a job change. If it does, the credit changes with it.

6. Check Medicaid and CHIP if you have crossed a state line. Eligibility rules differ, and a household that did not qualify in one state may qualify in another — or the reverse. Those programmes have no enrollment window and can be applied for at any time.

Keeping the evidence

Keep something that shows the old address, something that shows the new one, and the date. A lease, a utility connection, a closing statement, a change-of-address confirmation.

You may be asked to confirm the move. Assembling that at the time takes ten minutes; assembling it three months later takes an afternoon.

If you have missed the sixty days

Look for another qualifying event. Check Medicaid and CHIP, which are open all year. Otherwise the next Open Enrollment is the route — and if the plan you are carrying is not offered where you now live, ring the Marketplace and ask what your position actually is rather than waiting.

A note for seasonal and student households

Moving for seasonal work, or to and from a place you attend school, can qualify. So can moving back. If your household moves on a predictable annual rhythm, it is worth planning the coverage around it once rather than improvising each time.

Where to get help

HealthCare.gov handles the address change and shows the plans available at the new address. The Marketplace Call Center is on 1-800-318-2596, TTY 1-855-889-4325, free and open at any hour. Navigators and certified application counselors help in person and are not paid by insurance companies — localhelp.healthcare.gov.

We work across all four states. If you are moving within them, telephone us before the van is loaded and we will have the new county’s options ready.