Sarah Borders December 23, 2025 1 min read

Is a Significant Cost Increase to an Individual’s Public Exchange Marketplace Plan a Qualifying Event to Move to Group Health Coverage Mid-Year?

Q: Is a significant cost increase to an individual’s public Exchange Marketplace plan a qualifying event to move to group health coverage mid-year?

A: Generally, no. If the individual is being given a renewal option for their plan, they are not experiencing a qualifying event. However, if the plan they had is not being renewed but is being canceled, forcing the person to explore other Marketplace plan options, then the individual experiences a loss of coverage qualifying event that allows them to enroll in the group health plan mid-year.

Additionally, if the employer has a calendar year plan and the employee finds out they lose Marketplace coverage after the employer’s open enrollment, the election request could be honored as long as the election is submitted before the new plan year begins. The employer simply makes an exception to their internal deadline of when open enrollment elections must be submitted. It is worth ensuring the exception is not discriminatory and does not set an unreasonable precedent.

Sarah Borders

Principal, Benefits Compliance Solutions. Sarah has spent the last 15 years in the employee benefits industry, has numerous designations and serves on NAHU’s Employer Working Group Subcommittee and is an active board member of Austin AHU. She recently stepped down as Vice President of Benefits Compliance at one of the nation's largest brokerage firms to start her own compliance consulting practice. Her designations include an active license with the Texas Department of Insurance, CEBS (Certified Employee Benefits Specialist), Certified Health Care Reform Professional, HIPAA certification and Health Care Service Associate. She holds an MBA from Texas A&M Corpus Christi and a BA from University of Incarnate Word. Her consulting firm, Benefits Compliance Solutions, partners with employers to identify unknown risks and avoid hundreds of thousands of dollars in fines and lawsuits from failure to comply with their healthplan obligations.