Can I update my ACA plan if I have a baby?
Yes, having a baby is considered a qualifying life event under the ACA (Affordable Care Act), which allows you to update your health insurance coverage. This event triggers a Special Enrollment Period (SEP), giving you the opportunity to enroll your baby in health insurance or make changes to your existing ACA plan. Here’s what you need to know about updating your ACA plan after having a baby.
1. Qualifying for a Special Enrollment Period (SEP)
Having a baby qualifies you for a Special Enrollment Period, meaning you can update or change your health insurance outside of the annual Open Enrollment Period.
A. Timeframe for SEP
You have 60 days from the date of your baby’s birth to enroll your child in a health plan or make changes to your existing coverage. If you miss this window, you may have to wait until the next Open Enrollment Period to make changes unless another qualifying event occurs.
2. Options for Updating Your Coverage After Having a Baby
After your baby is born, you have several options for adjusting your health insurance through the ACA Marketplace:
A. Add Your Baby to Your Current ACA Plan
If you already have an ACA health plan, you can add your baby to your current plan during the Special Enrollment Period. This ensures your child is covered for medical care from birth.
B. Switch to a New Family Plan
You may decide to switch to a different plan to ensure the best coverage for your family. You can enroll in a family plan that covers both you, your baby, and your other family members.
You may also consider upgrading to a plan with lower deductibles or out-of-pocket costs to better suit your new family’s healthcare needs.
3. How to Update Your ACA Plan After Having a Baby
To update your ACA health insurance plan after the birth of your baby, follow these steps:
A. Log In to Your ACA Marketplace Account
Visit healthcare.gov or your state’s Marketplace website and sign in to your account.
Navigate to the Report a Life Change section.
B. Report Your Baby’s Birth
Select the option to report a change in family size due to the birth of your baby.
You will be asked to provide details about your child, such as the birthdate, and update your household information.
C. Enroll Your Baby in Coverage
Once you’ve reported the birth, you can add your baby to your current ACA plan or choose a new family plan.
Be sure to complete the enrollment process within 60 days of your baby’s birth to avoid gaps in coverage.
4. Eligibility for Subsidies After Having a Baby
After having a baby, your household size and income will be updated, which may affect your eligibility for premium tax credits or cost-sharing reductions to help lower the cost of your health insurance.
A. Premium Tax Credits
Premium tax credits are available to households with incomes between 100% and 400% of the Federal Poverty Level (FPL). These credits reduce the amount you pay for your monthly premiums.
If your household size increases with the addition of your baby, and your income remains the same, you may qualify for higher subsidies.
B. Cost-Sharing Reductions (CSRs)
If your income is between 100% and 250% of the FPL, you may also qualify for cost-sharing reductions (CSRs), which lower your out-of-pocket costs for healthcare services.
CSRs are available with Silver-tier plans in the ACA Marketplace.
5. Choosing the Right Plan After Having a Baby
When updating your ACA plan after the birth of your baby, it’s important to consider your family’s healthcare needs and financial situation. Here are a few factors to consider when comparing plans:
Premiums: Look at the monthly premiums for different plans to find a balance between what you can afford and the level of coverage you need.
Deductibles and Out-of-Pocket Costs: If you expect to have frequent medical expenses for your baby (such as doctor’s visits, vaccines, and prescriptions), a plan with lower deductibles and out-of-pocket costs may be beneficial.
Network of Providers: Make sure the plan you choose includes pediatricians and healthcare providers in your network that you want for your baby’s care.
Prescription Drug Coverage: Check that your plan offers good coverage for any medications or treatments your baby might need.
6. What Happens If You Don’t Update Your Plan?
If you do not update your ACA plan within the 60-day window after your baby is born, your child may not have health coverage until the next Open Enrollment Period unless you experience another qualifying life event. It’s important to act promptly to ensure your baby is covered from birth.
Key Takeaways:
Having a baby qualifies you for a Special Enrollment Period, allowing you to add your baby to your ACA plan or choose a new family plan within 60 days.
You may be eligible for higher premium tax credits or cost-sharing reductions based on your updated household size and income.
Ensure that your plan offers adequate coverage for your new family’s healthcare needs, including pediatric care and prescription medications.
For personalized help enrolling your baby in an ACA plan or updating your coverage, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
