The 2021 annual open enrollment period is when people can enroll in individual Affordable Care Act (ACA) qualifying health insurance for coverage beginning Jan. 1, 2021.
When is the annual open enrollment period? Open enrollment runs from Nov. 1, 2020 to Dec. 15, 2020 in most states. Some states have extended open enrollment periods after Dec. 15. Coverage for plans purchased during open enrollment begin Jan. 1, 2021.
Who is open enrollment for? Annual open enrollment is for anyone without employer-provided health benefits, a grandfathered health plan, and those who don’t qualify for Medicare or CHIP and still wish to obtain qualifying essential health benefits.
It’s also important that those living in a state with a state mandate to enroll to avoid penalties.
Where do you get ACA coverage? To obtain Exchange-based coverage, either apply on the Federally Facilitated Exchange (healthcare.gov) or from your state-based Exchange if your state operates one.
Why shop an Exchange? Because that’s where you can access federal subsidies, like premium tax credits or cost sharing reductions if you qualify for financial assistance. Learn more about shopping on vs off the ACA Exchange.
The basic enrollment information above largely remains the same year to year. However, there are a handful of changes to the ACA each year that it helps to be aware of as you begin the process of shopping for coverage.
Below, we’ll discuss some updates and potential future changes to know about, including:
- Pennie in PA
- Medicaid expansion in MO, OK
- Premium rate changes
- COVID-19 and the ACA
- 2021 Health Insurance Options
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Pennsylvania Moves to State-Run Exchange, Pennie
Pennsylvania residents have their own state Exchange this year, “Pennie,” instead of healthcare.gov.
States with their own exchanges can choose to extend the open enrollment period and Pennsylvania has done that for coverage year 2021, with an open enrollment period that extends from Nov. 1, 2020 to Jan. 15, 2021, a month longer than the federal enrollment period.
If you’re a Pennsylvania resident that has enrolled on healthcare.gov in previous years, be aware that your new ACA enrollment website is pennie.com.
Medicaid Expansion, Missouri and Oklahoma
A majority of states have expanded their Medicaid coverage under the ACA. In states that have expanded coverage, you can qualify based on income alone if your household income is 138% of the federal poverty level (FPL) or lower.
The most recent states to approve Medicaid expansion for coverage year 2021 are Missouri and Oklahoma.
Missouri voters approved a Medicaid expansion ballot measure in August, 2020 for expanded Medicaid coverage to begin July 1, 2021.
Similarly, Oklahoma voters adopted a similar measure June 30, 2020, with expanded Medicaid coverage to begin no later than July 1, 2021.
If you’re an Oklahoma or Missouri resident who didn’t previously qualify for Medicaid, particularly if your household income was just a bit over the limit, you may now qualify so it’s worth visiting healthcare.gov to find out.
To date, ACA Medicaid expansion has been adopted and implemented in 39 states. To find out the status of your state, check out Kaiser Family Fund’s (KFF) interactive map.
Estimated 2021 Premium Rate Changes
Estimated premium rate changes are calculated in the weeks leading up to open enrollment based on insurance companies’ rate filings.
Premium rate changes can vary a great deal from state to state, so a national average may not accurately reflect the rate changes where you live.
Premiums are shaping up for a minimal increase in 2021, indicating a relatively stable market.
So far, the national average based on preliminary (not final) rate filings is +2.1%.
Will COVID-19 Result in Higher or Lower Premiums in 2021?
It remains to be seen how much of an impact the COVID-19 pandemic will have on 2021 health insurance premiums.
For example, there could be higher costs to insurers due to increased COVID testing, people obtaining healthcare services in 2021 that they put off in 2020 due to the pandemic, and the potential for widespread vaccination (more on that next).
Or 2021 health claims costs could remain relatively stable due to a second (or third) wave of COVID infection in 2021 which would result in relatively stable premiums.
Will 2021 ACA Plans Cover a COVID-19 Vaccine?
Yes, ACA-regulated individual and group health plans will cover the COVID-19 vaccine once it is available.
Specifically, that means you’ll have coverage if you have one of the following types of health plans:
- Individual plans purchased on the ACA Exchange (healthcare.gov or your state’s ACA enrollment website)
- Individual major medical plans purchased away from the Exchange (i.e., directly from an insurance company)
- Employer’s qualifying group health plan
The new COVID-19 vaccine should come with no additional out-of-pocket costs as part of your ACA plan’s preventive health benefits.
Will the ACA be around in 2021 and Beyond?
With the death of Ruth Bader Ginsberg in September 2020 and the nomination of Amy Coney Barrett to the Supreme Court, speculation has increased in recent weeks that the ACA faces a very real possibility of being invalidated entirely or that people with pre-existing conditions will lose their coverage or face higher costs.
What is the actual risk to the Affordable Care Act in 2021? And does it change anything about this year’s open enrollment period?
Neither the Supreme Court nomination nor the case coming before the Court on Nov. 10, 2020, California v. Texas, should impact your ability to access ACA coverage during the 2021 open enrollment period.
In other words, if you were going to enroll in an ACA plan this year, you should proceed as planned.
That said, one of three potential outcomes is expected later in 2021 when the Supreme Court makes its final ruling on California v. Texas, which could have consequences for your access to an ACA plan:
- The challenge could be struck down, leaving the ACA in effect as it is today.
- The entire ACA could be invalidated, which would result in around 20 million Americans immediately losing their health coverage, including Medicare recipients and adult children under the age of 26 on a parent’s health plan.
- The pre-existing conditions mandate could be invalidated and the rest of the ACA could stand. Since around 54 million people have a disqualifying pre-existing condition, and another 46 million have a condition that would result in higher premiums or exclusions, this could have significant consequences for Americans’ ability to access affordable coverage.
The materials available at this web site are for informational purposes only and not for the purpose of providing legal advice. You should contact your attorney or to obtain advice with respect to any particular issue or problem.
COVID-19 is a Pre Existing Condition
The potential of losing guaranteed pre-existing conditions coverage is particularly relevant at this point in time as so many Americans now have a pre-existing condition as a result of having COVID-19.
If the ACA is overturned, or the pre-existing conditions mandate is repealed, insurers could discriminate against people who have had COVID-19 by refusing them coverage or charging them a higher premium.
And even those that have not contracted COVID-19 could still be singled out for exclusions or denied coverage if they work in a higher risk job, such as a front line or essential worker.
Your 2021 Health Insurance Options + Next Steps
Whether you routinely enroll in health benefits through ACA open enrollment or you’re one of the millions of Americans that lost their employer benefits this year and are shopping for individual coverage for the first time, it’s time to start thinking about 2021 health insurance.
And this year, with COVID-19 still largely uncontrolled in the U.S., you may need to factor in your risk for contracting COVID-19 and possibly requiring testing or treatment if you contract the disease.
If you think you could be at an increased risk of developing more serious coronavirus symptoms, then getting the right kind of health insurance to provide unlimited benefits for hospitalization may be important.
Let’s look at the two options that tend to be discussed the most during open enrollment and beyond:
- ACA plans (also sometimes referred to as “major medical” plans)
- Short term medical insurance plans (also referred to as “term” or “limited benefit” coverage)
Major Medical Plans
Individual ACA-qualifying health plans are those that comply with the guidelines of the Affordable Care Act.
Today, that means that they:
- Are guaranteed issue and cover pre-existing conditions without charging you a higher premium
- Cover the 10 essential health benefits as outlined in the ACA.
- Include dental coverage as an essential health benefit for children 18 years old or younger.
- Are eligible for tax credits or subsidies if you meet the qualifications.
- Are available only during the annual open enrollment period or a special enrollment period if you qualify.
- Are qualifying coverage if you live in a state that has an individual mandate penalty.
- Don’t have annual maximum or lifetime maximum limits on essential health benefits.
- Base premium costs on your age, location, tobacco use, plan category, and number of people on the plan. Factors like sex and health status or family health history cannot be used to charge you more for coverage.
Individuals can access ACA-qualifying plans a number of ways depending on their eligibility. For example:
- From the Federal Marketplace (or your state Exchange), these individual ACA health plans and are eligible for ACA subsidies if you qualify
- Away from the Exchange, these individual ACA-qualifying health plans are not eligible for subsidies
- Via TRICARE, CHIP, Medicaid or Medicare, also ACA-qualifying coverage if you qualify to take advantage of one of these programs
If you think the comprehensive benefits that the ACA provides are important for you or your family, then your next steps are to:
2. Determine where to shop for your ACA plan if you do not qualify for subsidies or Medicaid – you may have more plan options by shopping away from the Exchanges (i.e., directly from insurance companies).
Enroll in an ACA Health Plan During the Annual Open Enrollment Period.
Short Term Health Insurance
Some people may wish to consider non-ACA options like short term medical coverage. Why? There are a few potential reasons…
ACA plan premiums can be cost-prohibitive for those that do not qualify for financial assistance.
Some people choose to use very few healthcare services, for example, they may not visit the doctor for annual health exams or utilize vaccines and only go to the doctor when they get sick.
Still, others may be planning to secure job-based coverage soon. Even though ACA plans can be canceled anytime, they may want to try to save on premium cost by forgoing health insurance coverage temporarily.
Short term medical premiums tend to be lower than unsubsidized ACA plans because benefits are limited and those with pre-existing conditions are excluded.
These plans are designed to help people access temporary and limited medical benefits for things like hospitalization, emergency care, and doctor’s office visits while they’re between ACA or employer-provided plans. However, they should not be considered a substitute for a comprehensive ACA plan because there are several limitations.
Short term health plans:
- Are not available in all states
- Don’t cover pre-existing conditions and are not guaranteed issue
- Don’t cover the essential health benefits
- Have benefits limits
- Include a list of exclusions and limitations
- Typically can be used anywhere without network restrictions
- Are not subject to the annual open enrollment period
If short term health insurance sounds like a fit for your needs, you live in a state that permits them and you qualify, it just takes a few minutes to obtain quotes for multiple plans and enroll in coverage. You can even begin coverage the next day.
Find out if temporary plans are available in your state and compare costs.
Summary and Next Steps
It’s difficult to know what to expect during open enrollment 2021 as it’s taking place at the same time as a COVID-19 pandemic, a Supreme Court vacancy, and a general election that could have significant consequences for the country in terms of COVID-19 relief, economic recovery, and the future of health insurance and healthcare access in the U.S.
One thing that hasn’t changed is the importance of being prepared and informed when it comes to your health coverage options. In fact, it may be more important now than ever!
For more of our ACA open enrollment content to help you plan and prepare, check the guide below.
And as always, if you have questions and wish to speak with a health insurance agent about your options, call 888-855-6837.
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