- Open enrollment for 2020 coverage has ended, but opportunities to enroll in ACA-compliant coverage are changing by the day in response to the developing coronavirus crisis.
- The open enrollment period (OEP) is an annual opportunity to shop for ACA-compliant coverage. If you don’t buy during this OEP, your buying options will be limited until the next OEP.
- In any state, you can enroll outside of the OEP if you have a qualifying life event.
- ACA open enrollment only applies to the individual health insurance market.
- Consumers can enroll in ACA-compliant coverage through an exchange or off-exchange – and with the help of agents and brokers.
- The ACA’s subsidies are critical to affordability.
- For millions who can’t afford ACA-compliant coverage, short-term coverage could provide a temporary safety net.
- Federal rules for short-term health plans, which took effect in 2018, have expanded consumers’ access to short-term plans in many states.
Outside of open enrollment, Americans can purchase ACA-compliant coverage if they have a special enrollment period – and some states have been adding coronavirus-related special enrollment periods in recent days.
Although ACA’s open enrollment period has ended, millions of Americans still have an opportunity to enroll in an ACA-compliant plan (or switch to a different plan) – if they they’re eligible for a special enrollment period. And SEPs now include special enrollment periods triggered by the coronavirus pandemic in the following states:
- Connecticut – SEP through April 2
- Colorado — SEP through April 3
- Washington State – SEP through April 8
- Maryland – SEP through April 15
- Rhode Island – SEP through April 15
- New York – SEP through April 15 both on- and off-exchange
- Nevada – SEP through April 15
- Vermont — SEP through April 17
- Minnesota — SEP through April 21
- Massachusetts – SEP through April 25
- California — SEP through June 30
(The District of Columbia is also offering a special enrollment period. Though it’s not related to COVID-19, it does present an opportunity for uninsured residents to get coverage during this crisis.)
Read more details about SEPs triggered by exceptional circumstances.
As our updated Insider’s Guide to Obamacare’s Special Enrollment explains, there’s a long list of qualifying events that could trigger a special open enrollment window for you. Among them:
- a permanent move
- involuntary loss of other coverage (as long as it was minimum essential coverage)
- divorce, death or separation that results in a loss of coverage
- change in citizenship or lawful immigrant status
- growth of your family due to marriage, birth, adoption or foster care
Most special enrollment periods apply both on-exchange and off-exchange, although it essential for anyone who is eligible for premium tax credits to enroll through the exchange if and when they have a special enrollment period.
Depending on your household income, you may be eligible for premium tax credits (aka, premium subsidies) and possibly cost-sharing reductions (CSR, aka, cost-sharing subsidies). Don’t sign up for an off-exchange plan and miss out on the possibility of much more affordable premiums via a tax credit.
Without a qualifying event, ACA-compliant coverage is generally not available outside of open enrollment. (There are some exceptions: Native Americans can enroll year-round, and so can anyone eligible for Medicaid or CHIP.)
Your options for obtaining ACA-compliant coverage are limited if you don’t enroll during open enrollment. The next open enrollment period will start in November 2020, for coverage effective in 2021.
The November 1 – December 15 enrollment window is for people who buy their coverage in the individual market. If you have employer-sponsored coverage – or if you’re covered by Medicare, Medicaid, Tricare or the Indian Health Service – different enrollment windows apply for your coverage.
Medicare’s enrollment window is similar, but it ends on December 7. And your employer’s enrollment window may very well happen during this time of year, but it will have its own dates. (If you’re eligible for Medicaid or CHIP, you can enroll at any time during the year.)
People eligible to enroll during the OEP or a special enrollment period have several options for buying ACA-compliant coverage:
- Through a marketplace – your state’s exchange or HealthCare.gov. These exchanges vary by state, but were designed to make it easy for people to compare plans, determine eligibility for subsidies, and enroll in ACA-compliant coverage. Find out what type of exchange your state uses.
- From agents and brokers who are certified by the exchanges to help explain ACA-compliant coverage options, determine your eligibility for subsidies, and make plan recommendations based on your situation. Learn more about brokers and agents.
- Through online portals – including healthinsurance.org – where you can find a quick health insurance quote or get help enrolling in an ACA-compliant plan from a licensed, exchange certified broker. (Call 1-844-608-2739 to talk to a certified broker.)
Open enrollment or a special enrollment period is definitely an opportunity to shop for affordable comprehensive individual health coverage. Thanks to premium and cost-sharing subsidies established by the Affordable Care Act (aka Obamacare), buying an affordable major medical plan is a realistic option for millions of Americans who are eligible.
Premium subsidies – which are actually premium tax credits – can lower the costs of any metal-level ACA-compliant plan bought through the exchange in your state (this includes plans purchased via “enhanced direct enrollment” entities that work with the exchange, as well as brokers and agents who help clients enroll in plans through the exchange). Here’s how to find out whether you’ll be eligible for a subsidy.
If you think it’s likely you’ll be eligible for a subsidy, be sure to familiarize yourself with the basics of ACA subsidies. You’ll want to make sure that you get the maximum subsidy but also that you understand your options for claiming your subsidy. (Your choice in how to receive a subsidy could determine whether you’ll end up repaying some or all of your subsidy.)
The cost of your plan will depend on a number of factors, including some that are specific to you (your household income, zip code, tobacco use, and the number of people who will be covered under your plan) as well as things like plan availability in your area, and your state’s efforts to help control the cost of coverage.
Health coverage is sort of like airline tickets: Chances are, you’re not paying the same amount as your neighbor. Roughly half of Americans get their health insurance from an employer — with varying premiums — and more than a third get coverage from Medicare — also with varying premiums — or Medicaid.
There are also about 15 million people who buy their own health insurance in the individual market. For these folks, premiums vary considerably based on where they live, how old they are, and how much they earn. In most states, premiums can also vary based on tobacco use.
So what are people actually paying for individual plans that they buy for themselves? As of mid-2019, there were about 10.2 million people with effectuated coverage through the exchanges. Their average per-person premium was about $593 per month, but that was before any income-based premium subsidies were applied: Eighty-seven percent of those enrollees were receiving premium subsidies, which reduced their monthly premiums by about $514.
There’s a lot of variation from one state to another — average premiums were $947 per month in Wyoming, and $391 per month in Massachusetts. But in every state, premium subsidies cover the majority of the premiums for the majority of enrollees. And millions of people, including more than 4 million who were uninsured as of 2019, can get coverage with no premium at all, because the available subsidies are enough to cover the entire premium.
People who don’t get subsidies pay full price, and this includes anyone who buys their coverage outside the exchange. But some of these people may have employers who cover some or all of the cost via a health reimbursement arrangement.
For people who simply can’t afford an ACA-compliant plan, short-term health plans are an option in most states. These policies can have premiums under $50 per month for younger people. And although the rates are higher for older people, a 50-something applicant will generally see numerous short-term plans with premiums under $250 per month.
Health insurance – also referred to as medical insurance or healthcare insurance – refers to insurance that covers a portion of the cost of a plan holder’s medical expenses. How much the insurance covers depends on the type of coverage and specifics of the policy.
Types of insurance include individual health insurance, employer-sponsored group insurance, Medicare, Medicaid, CHIP, Tricare and insurance for government employees (FEHB). If you’re reading this, it’s likely because you’re seeking information about individual health plans – which include Obamacare (ACA-compliant) plans.
Those plans are major medical insurance that was mandated by the law to include essential health benefits and offer coverage on a guaranteed-issue basis. Types of ACA plans include preferred provider organization (PPO) plans and health maintenance organization (HMO) plans, but also point-of-service (POS) plans and exclusive provider organization (EPO) plans.
There is no “best health insurance policy.” There’s really only a health plan that best fits your specific situation. For some people, that might mean the plan with the lowest premium, but there’s a lot more to it than that. To choose the best plan, you’ll also want to look at other factors – including provider networks, out-of-pocket costs, and the new star ratings.
You can learn more about how to shop for a plan that’s perfect for you in our Insider’s Guide to Obamacare’s Open Enrollment.
Here’s an at-a-glance overview of some things to be aware of for 2020 health plans — including lots of states where new insurers have joined the exchange, updated subsidy-eligibility guidelines (and new subsidies in California), new individual mandates in California and Rhode Island, a new state-run enrollment platform in Nevada, and lots more. You’ll find more details in our Insider’s Guide to Obamacare’s 2020 Open Enrollment.
Because ACA-compliant plans offer a long list of coverage protections – and the potential for subsidies to reduce premiums and out-of-pocket costs – we encourage our readers to explore ACA-compliant coverage options first. At the same time, we do recognize that there is a segment of the individual market population that can’t or won’t purchase ACA-compliant coverage:
- Millions of Americans are caught in the coverage gap in states that haven’t adopted the ACA’s Medicaid expansion.
- Millions of other Americans are stranded by the family glitch, which makes them ineligible for subsidies.
- Other Americans with incomes above 400 percent of the poverty level – and thus ineligible for the ACA’s subsidies – simply can’t afford the coverage costs of ACA-compliant plans. [It’s essential to understand how “income” is calculated under the ACA, and to know that pre-tax retirement plan contributions and HSA contributions will reduce your income and potentially make you eligible for a subsidy, even if you start with an income above 400 percent of the poverty level.]
The good news: there’s a wide range of short-term health coverage available in most states that could provide a temporary safety net until these consumers get access to more comprehensive coverage.
Consumers who are unable to afford ACA-compliant coverage can now purchase short-term coverage with a much longer duration in many states. Federal regulation changes in late 2018 made it possible for many buyers to purchase a short-term plan with an initial duration of nearly a year – with renewal options that allow the plan to remain in force for up to three years.
- Does your state regulate short-term coverage? Read about plan and carrier availability.
- Read more FAQs about short-term health plans.
Louise Norris is an individual health insurance broker who has been writing about insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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