Today we’ll cover steps you can take to prepare for and enroll in private individual health insurance during the annual Affordable Care Act (ACA) open enrollment period.
For coverage beginning Jan. 1, 2021, the open enrollment period for most states is from November 1, 2020, through December 15, 2020.[1]
However, a handful of states that operate their own exchanges have opted to extend open enrollment through the use of special enrollment periods.
Note that your new policy’s effective date will vary depending on when you enroll if doing so through an extended special enrollment period:
- California: Oct. 15, 2019 to Jan. 15, 2020 – California passed legislation to enact a permanent 3-month health insurance open enrollment period.[2]
- Colorado: Nov. 1, 2019 to Jan. 15, 2020 – Colorado passed legislation to enact a “market stabilization special enrollment period” that permanently extends the standard open enrollment period.[3]
- Massachusetts: Nov. 1, 2020 to Jan. 23, 2021.[4]
- Minnesota: Nov. 1 through Dec. 22, 2020.[5]
- Nevada: Nov. 1, 2020 to Jan. 15, 2021.[6]
- New Jersey: Nov. 1, 2020 to Jan. 31, 2021.[7]
- New York: Nov. 1, 2020 to Jan. 31, 2021.[8]
- Pennsylvania: Nov. 1, 2020 to Jan. 15, 2021.[9]
- Rhode Island: Nov. 1, 2020 to Jan. 23, 2021.[10]
- Washington D.C.: Nov. 1, 2019 to Jan. 31, 2020 – A “special enrollment period for future open enrollment periods” motion was passed in May, 2019 to permanently extend the open enrollment period to three months.[11]
Remember, unless you qualify for a special enrollment period or another form of minimum essential coverage that offers year-round enrollment, like Medicaid, you can only enroll in individual major medical insurance during annual open enrollment. So it’s a good idea to take some time right now to review your healthcare needs, current/past insurance coverage, and make some decisions for the coming year.
In the remainder of this blog post, we’ll walk you through the steps to take to get ready for and enroll in health insurance during the 2020 open enrollment period.
How to Prepare for 2021 Open Enrollment and Get Coverage
Follow the steps below to make sure you get coverage to fit your needs in 2021.
1. Get up to speed – understand what has changed for the ACA in 2021.
- Remember, there is still no federal tax penalty for going without ACA-qualifying minimum essential coverage in 2021, however, some states have their own penalties.
Remember, if a medical concern is discovered during a routine or preventive care check, it could cause you to become ineligible for some non-ACA health insurance options.
2. Understand your options if you’re shopping around for individual health insurance:
- If you had individual major medical coverage in 2020, be on the lookout for a letter from your insurance company and/or the ACA Exchange likely arriving in October. Review these materials and decide if you should automatically re-enroll in your current plan or shop around.
- If you’re enrolling in individual coverage for the first time or you know your previous plan no longer fits your needs, review this complete guide to choosing health insurance to understand your options.
- Make sure you know the difference between ACA health insurance and limited benefit insurance policies like short term medical insurance.
- Already planning to enroll in major medical insurance? Make sure you understand the ACA metal levels so you get the right cost-sharing structure for you.
2a. Understand your group health coverage options if you get benefits through your employer:
- Learn about health reimbursement arrangements (HRAs) if your employer is offering either an excepted benefit HRA or an individual coverage HRA for the upcoming plan year.
- Understand and enroll in additional benefits that you may need if they’re available, such as long or short term disability, critical illness and/or accident insurance, dental insurance, vision insurance, and life insurance.
- Avoid being underinsured – employees in group plans are the fastest-growing group of underinsured Americans.[12] Supplemental medical gap insurance may help.
Because of this, if you are maintaining a grandfathered health insurance policy, make sure it has withstood the test of time and still offers you the level of benefits and coverage you need. Conversely, if your insurance company stops offering your grandfathered plan, you’ll have to shop around this year. Learn more about grandfathered health plans, including options if your grandfathered health plan is canceled.
3. See if you qualify for a subsidy for ACA health insurance in 2021.
- Learn how to estimate your income for 2021 (Healthcare.gov).
- Use the ACA Subsidy Calculator and get detailed information about your health insurance options based on your results.
4. Enroll in coverage. If you’re enrolling in individual insurance:
- Decide whether to enroll in a plan from the public ACA Exchange or away from the Exchange. (If you plan to use a federal subsidy, you’ll have to select a plan from the ACA Exchange.)
- Find out where to access your ACA Exchange – some states run their own websites while others use healthcare.gov.
- When you enroll in ACA coverage, you’ll need to provide basic information about your household members and income. Make sure you have all the materials you need to make the enrollment process smoother (Healthcare.gov).
- Opting for non-ACA, limited benefit health insurance? Get a short term health insurance quote to compare plans in your area (it just takes a minute to generate results). Remember, these are not ACA-qualifying so are not guaranteed-issue and cover few if any of the essential health benefits like preventive care.
- Make sure to follow safe online shopping practices when sharing sensitive information and enrolling online.
5. Know where to get help:
- For ACA plan help, find local help from Healthcare.gov or contact the Marketplace Call Center at 1-800-318-2596.
- Speak to a Health eDeals agent by calling 888-855-6837 for help understanding your individual health insurance options.
- For help with your employer-provided group benefits, speak to a representative at your workplace.
6. Consider Supplemental Insurance:
- If you’re underinsured or have a coverage gap, you may have trouble affording your deductible. Consider supplemental medical gap insurance to help with out-of-pocket costs and even costs that are not associated with your healthcare, like transportation and housing.
- Don’t forget dental insurance for the family. While coverage may be available to you and your dependents via an ACA plan, you will likely find more options to choose from in the private marketplace. Get a quick quote for dental insurance.
Summary + Next Steps
Health insurance is unique for each person and family, and health and financial circumstances can change from year to year.
That’s why it’s important to review your coverage and policy options each year when open enrollment comes around to ensure you have the right kind of coverage and enough benefits for the type of healthcare you’re likely to need.
There is no single coverage or benefits solution that works for every situation. ACA-qualifying major medical coverage may be enough for you.
Or you may find that you want to supplement your major medical benefits to help with out-of-pocket costs.
Or if you tend to be healthy and prefer to pay a lower premium[14] for less coverage and benefits, preferring to pay more of your healthcare costs on your own, you may opt for a limited benefit medical policy (your premium amount ultimately depends on the benefits you select).
Work the steps and find the right fit for you – and make sure to do it before the end of open enrollment! Remember, for most people, once open enrollment is over, it’s difficult to enroll in major medical insurance until the next open enrollment period.
Need help? Speak to a licensed agent by calling 888-855-6837 to talk through your coverage options.
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