Tag: Health Insurance Coverage
Ensure Your Health Care Coverage
November 15, 2020
Changing your calendar to the month of November signals the need to review your health insurance coverage for the coming year. If you don’t have health insurance coverage through an employer, you’ll need to buy it yourself if you want coverage in 2021.
The Affordable Care Act (ACA) (also known as Obamacare), enacted in March 2010, called for the creation of a health insurance exchange in each state, with three primary goals:
- Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level.
- Expand the Medicaid program to cover all adults with income below 138 percent of the federal poverty level.
- Support innovative medical care delivery methods designed to lower the costs of health care in general.
In the article, “Insurance Coverage after Job Loss—The Importance of the ACA during the Covid-Associated Recession,” published on October 22 in The New England Journal of Medicine, the authors state, “The ACA, having created several new options for health insurance unrelated to employment, will protect many recently unemployed people and their families from losing coverage.” The article also emphasizes, “The very virus that has brought about record unemployment levels is the same agent that makes health insurance—and the new options created under the ACA—more important than ever.
Open Enrollment for 2021
In every state, open enrollment for ACA-compliant 2021 health coverage for individuals and families started on November 1 and, in most states, will end on December 15, 2020. This deadline applies to the 36 states that use HealthCare.gov and it also may apply in some of the states that run their own exchanges.
You can enroll for a health insurance plan online, over the phone, or in-person. When you enroll in a plan through the exchange, you need to have the following information on hand for each enrollee:
- Name, address, email address, Social Security number, birthdate, and citizenship status.
- Household size and income if you’re planning to apply for premium subsidies or cost-sharing reductions. A wide range of documentation can be used to prove your income, including pay stubs, W2s, or your most recent tax return.
- Coverage details and premium for any employer-sponsored plan that’s available to your household (regardless of whether you’re enrolled in that plan or have declined it).
- Payment information that the insurer will be able to use to charge your premiums.
- Your doctors’ names and zip codes, so that you can check to make sure they’re in-network with the health plans you’re considering.
- A list of medications taken by anyone who will be covered under the policy. Each insurance plan has its own formulary so you’ll want to check to see which one will best cover the medications you need.
- If you want to enroll in a catastrophic plan and you’re 30 years old or older, you’ll need a hardship exemption (note that premium subsidies cannot be used with catastrophic plans, so these are generally only a good idea if you don’t qualify for a premium subsidy, but can meet the requirements for a hardship exemption).
Coverage Effective January 1
In almost all cases, your coverage will take effect on January 1, 2021 if you sign up during the open enrollment window in the fall of 2020. If you’re already enrolled in an individual-market plan and you’re picking a different plan during open enrollment, your current plan will end on December 31 and your new plan will take effect seamlessly on January 1 if you continue to pay your premiums.
December Deadline Limitations
If you don’t enroll in an ACA-compliant health insurance plan by the end of open enrollment on December 15 in most states, your buying options may be limited for the coming year. Open enrollment won’t come around again until November 2021, with coverage effective January 1, 2022. Exceptions include:
- Medicaid and CHIP enrollment are available year-round for those who qualify. If your income drops to a Medicaid-eligible level later in the year, you’ll be able to enroll at that point. Similarly, if you’re on Medicaid and your income increases to a level that makes you ineligible for Medicaid, you’ll have an opportunity to switch to a private plan at that point, with the loss of your Medicaid plan serving as the qualifying event that triggers a special enrollment period.
- Native Americans can enroll year-round in in plans through special provisions in the ACA that apply to Native Americans.
- If you have a qualifying event during the year, you’ll have access to a special enrollment period. Qualifying events include marriage (if at least one spouse already had coverage prior to the marriage), the birth or adoption of a child, loss of other minimum essential coverage, or a permanent move to a new geographical area where the available health plans are different from what was available in your prior location (if you already had coverage prior to your move).
You can access a guide to all of the qualifying events that trigger special enrollment periods in the individual market including details about the specific rules that apply to each of them.
No Federal Penalty but Some States Levy Tax Penalties
There is no federal government penalty for being uninsured in 2021 but four states (Massachusetts, New Jersey, California, and Rhode Island) and Washington, DC, impose tax penalties for not having health insurance.
For More Information About ACA-Healthcare Coverage
Follow these steps:
- Get a quotation at healthinsurance.org.
- ‘Window shop’ anonymously on your state exchange (if you’re in Washington, DC, or one of the 14 states that run their own exchanges) or HealthCare.gov’s plan browsing page if you’re in one of the other 36 states.
- Consult with a trained advisor by setting up an appointment with a navigator or broker in your area who will be able to help you sort through the available options and figure out which one will best meet your needs.
- Talk with your health care providers if you’re considering a policy change during open enrollment. You’ll want to know which provider networks include your doctors, and whether any network changes are planned for the coming year.
Auto-Renewal for Existing ACA-Compliant Health Plan
If you’re already enrolled in an ACA-compliant health plan through your state’s marketplace, you can probably let your plan automatically renew for 2021. Auto-renewal is an option for nearly all exchange enrollees, although Pennsylvania and New Jersey have transitioned away from HealthCare.gov and are using their own new enrollment platforms instead. Residents in those states need to pay close attention to notifications they receive from the marketplace with instructions on how to renew coverage or select a new plan for 2021.
But, relying on auto-renewal for ACA-compliant insurance coverage may not be in your best interest. No matter how much you like your current plan, it pays to shop around during open enrollment and see if a plan change is worth your while because:
- In most states, you won’t be able to pick a new plan after your coverage is auto-renewed.
- Your subsidy amount will generally change from one year to the next. If your subsidy gets smaller, auto-renewal could result in higher premiums next year.
- If you receive a subsidy, auto-renewal could be risky even if the subsidy amount isn’t declining. This FAQ explains details that you may encounter if you let your individual health insurance plan automatically renew.
- If your plan is being discontinued, auto-renewal will result in the exchange or your insurer picking a new plan for you.
- Auto-renewal might result in a missed opportunity for a better value.
You might still decide that renewing your current plan is the best option for 2021. But, it’s definitely better to actively make that decision rather than letting your plan auto-renew without considering other available options.
After you have squared away your health care coverage for 2021, you can record all the decisions you make, enrollment forms you submit, and confirmations you receive at InsureYouKnow.org. By doing that, you’ll be able to review your health insurance coverage commitments in November 2021 in preparation for 2022.