When a marketplace health plan is discontinued, clients don’t have to start from scratch. Instead, they’re typically transitioned automatically into a comparable plan — a process known as a crosswalk.
Below, we’ll break down how crosswalks work, why they exist, and what both you and your clients should keep in mind during the transition.
What Is a Crosswalk?
A crosswalk in health insurance refers to the process of moving enrollees from a discontinued plan into a new one that closely matches their previous coverage level and tier.
You might also hear this referred to as health plan mapping, but the Centers for Medicare & Medicaid Services (CMS) officially calls this process a crosswalk.
How Crosswalks Work in the ACA Marketplace
If a carrier stops offering a certain plan — or exits the marketplace altogether — affected clients receive a notification that their coverage will end. To prevent a lapse, the marketplace (or the carrier) will automatically place them into a new plan with comparable benefits and the lowest available premium.
This process applies across all plans in the federal marketplace (FFM). However, state-based marketplaces (SBMs) handle it differently. Some states automatically crosswalk enrollees to new coverage, while others simply notify clients that their plan is ending and invite them to choose a replacement during a Special Enrollment Period (SEP).
Each state sets its own procedures, so it’s important to confirm how your client’s state marketplace manages discontinued plans.
How Clients Can Avoid Being Automatically Crosswalked
Before a plan ends or a carrier exits the exchange, clients will receive advance notice — usually by mail — a few months before Open Enrollment (OEP) begins.
Encourage your clients to:
-
Carefully read all communications from their insurer or the marketplace.
-
Take action if they prefer a different plan than the one chosen for them.
If they receive a crosswalk notice, they have 60 days to choose another plan during an SEP, or they can wait and make a new selection during the OEP.
By choosing their own coverage, clients maintain control over their benefits, doctors, and premium costs — though in many cases, the crosswalked plan is already a close match. As their agent, it’s best practice to review all available plans in their area to ensure they’re getting the most suitable option.
Why Crosswalks Exist
Crosswalks serve an important purpose: protecting consumers from losing coverage when plans change or carriers withdraw.
The Affordable Care Act (ACA) was designed to ensure Americans have continuous, affordable access to health insurance. Automatically enrolling clients in a similar plan helps prevent gaps in coverage — one of the key reasons the national uninsured rate has dropped from 16% before the ACA to about 8% today.
Crosswalks also keep individuals within the health insurance exchange rather than shifting them to off-exchange plans, ensuring they continue to qualify for cost-sharing reductions and tax credits.
What to Watch for When a Client Is Crosswalked
While crosswalks are meant to simplify transitions, some details can change — and it’s important for clients to review them closely.
1. Premiums
The new plan’s premium may be higher, even if the coverage level is similar. This can happen if the new carrier or product line prices differently or has a smaller network.
2. Networks and Providers
The new plan may include a different network of doctors or hospitals. Some clients may need to switch providers or face higher out-of-network costs to continue seeing their preferred physician.
3. Subsidies and Cost-Sharing Reductions (CSRs)
Clients receiving premium tax credits or CSRs will typically keep those benefits as long as their eligibility hasn’t changed.
However, they must:
-
Keep their income and household information up to date in their marketplace account.
-
Continue filing their federal tax return each year — otherwise, they’ll lose eligibility for subsidies.
If a client currently receives subsidies, they’ll usually be crosswalked into a Silver-tier plan, since that’s the only metal tier eligible for CSRs. You can estimate updated subsidy amounts using the calculator on HealthCare.gov.
4. Coverage Effective Dates
For enrollments made before December 15, coverage begins January 1. Changes made after that date take effect February 1.
(State-based marketplaces may follow slightly different timelines.)
Updates Coming for Plan Year 2026
The Department of Health and Human Services (HHS) has finalized new rules that affect how crosswalks and re-enrollments will operate beginning with the 2024 Open Enrollment Period, impacting coverage for plan year 2026.
Elimination of the Re-Enrollment Hierarchy Standard
Previously, marketplaces could automatically move CSR-eligible Bronze plan members into Silver plans with better cost-sharing and lower net premiums. This is no longer permitted.
Going forward, clients must make their own plan selections. Agents should remind CSR-eligible clients that only Silver-tier plans qualify for these savings — and that in many cases, Silver coverage with CSRs may cost less than a Bronze plan.
Changes in Metal Tier Availability
If a client’s higher-tier plan (Silver, Gold, or Platinum) is discontinued and no comparable plan is available within the same tier, they may be crosswalked into a lower-tier plan. This can affect their premium, deductible, and covered benefits.
Encourage clients to review their options during OEP to find the best balance between cost and coverage.
Final Thoughts
Plan crosswalks — or health plan mapping — are built into the ACA to help protect consumers, reduce coverage gaps, and minimize disruptions.
As your client’s trusted advisor, remind them to read all correspondence from their insurer, verify their updated plan details, and make informed decisions about their coverage. Empowering them with this knowledge helps ensure that they stay protected, supported, and in control of their health care choices.
Not affiliated with or endorsed by Medicare or any government agency.
GET CONTRACTED WITH ESSENTIAL CARE INSURANCE AGENCY
For more information, please contact our office at (347) 971-3399 or send an email to rdashevskyy@essentialcare.info. Essential Care Insurance Agency provides Free Programs and Sales Tools for our Agents:
Please click on each link to learn more