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Between November and December, every year, is when people are allowed to sign up for a health insurance plan for the first time or make changes to their existing plan. We’ve collected the key dates, deadlines and answered the most common questions to make this year’s open enrollment as seamless as possible.
Key Dates And Deadlines For Healthcare Marketplaces During Open Enrollment 2021
|When does open enrollment start?||November 15th|
|When is the deadline to enroll?|
|For Minnesota||Dec 22, 2020|
|For Colorado||Jan, 15 2021|
|For Nevada||Jan, 15 2021|
|For Pennsylvania||Jan, 15 2021|
|For Washington||Jan, 15 2021|
|For Massachusetts||Jan, 23 2021|
|For Rhode Island||Jan, 23 2021|
|For California||Jan 31, 2021|
|For District of Columbia||Jan 31, 2021|
|For New Jersey||Jan 31, 2021|
|For New York||Jan 31, 2021|
|For all other states||December 15, 2020|
|When does coverage begin?||January 1, 2020 (or after you enroll if you live in a state that’s extended open enrollment)|
The 10 Essential Benefits That Are The Same For All Marketplace Plans
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
Who is eligible to shop during Open Enrollment?
Not sure if you’re eligible to shop the Marketplace for an Obamacare plan? Good news: you probably are!
If you are a U.S. citizen, national or legal resident of the United States who currently resides in the U.S., you’re qualified to shop the Marketplace. This includes green card holders, refugees, asylees, and individuals with non-immigrant status who have a valid worker visa.
The only exceptions? If you’re currently enrolled in Medicare or currently incarcerated.
What If My Employer Offers Insurance?
If your employer offers ACA-compliant health insurance and you choose to opt-out of it and purchase your own Obamacare plan, you usually won’t be eligible for any subsidies and will need to pay full price for your monthly premiums. Because of this, if you have access to health insurance coverage through your employer, we recommend you utilize that instead of the Marketplace, unless your employer insurance costs more than 9.78% of your household income.
Will I Have To Pay A Fine If I Don’t Have Health Insurance In 2021?
Congress repealed the penalty for having health insurance in 2018. That means in most states, you won’t have to pay a fine if you go without coverage in 2021.
However, the following states passed their own individual mandates, you may have to pay a penalty.
Which States Have A Penalty If I Don’t Have Health Insurance?
- New Jersey
- Rhode Island
- Washington D.C.
What do I need when I’m ready to enroll?
You’ll need some basic information on-hand to get started with the Open Enrollment process.
First, you’ll need to provide information about your household, including household size (including anyone you claim on your tax return). For each of these people, you’ll need some basic information like birth dates, home addresses, and social security numbers.
Additionally, you’ll need information about your best estimate for your 2021 income, information on how you file your taxes if you have a spouse, information about your sources of income, and policy numbers from any current health insurance plans.
You should also ask yourself these questions:
- What type of plan is it?
- Health Maintenance Organization (HMO) – does not have out of network benefits
- Preferred Provider Organization (PPO) – has in and out of network benefits
- Health Saving Account Plans (HSA) – lets you save for medical expenses on a tax deferred basis
- Are my current doctors and specialists and hospitals covered (in-network)?
- Are my current medications covered (in-network)?
- What will I be paying including premiums and out of pocket costs?
- Are any of my medical needs excluded?
What if I already have a plan from last year?
If you had Marketplace health insurance in 2020, you will be automatically re-enrolled in that plan for next year if that plan is still being offered. If that plan is no longer available, you’ll be enrolled in an “equivalent” plan. Although that might sound like the easiest way to approach OEP, it isn’t necessarily your best option. In fact, people who who shop and switch plans save an average of 38% on their monthly premiums.
Most insurers are expanding their coverage areas this year, which means there will be more plans available to you. Without shopping to compare what plans, and savings, are available to you this year, your premium payments may increase substantially. Plan details can change from year to year, too, meaning that prescription coverage, provider networks, and coverage benefits could change even if you keep the same plan. By shopping the Marketplace, you’ll find out what kinds of available plans might best suit your needs for the coming year, and what cost savings you will be eligible for with those plans. It only takes a few minutes to shop and compare your options, and this can keep you from paying more later.
Am I Eligible For Subsidies, Cost-sharing Reductions, And Tax Credits?
Many Americans are eligible to save on their health insurance costs as a result of the Affordable Care Act. No matter where you live, if you earn between 100 – 400% of the Federal Poverty Level (determined by the federal government) and aren’t eligible for Medicaid, you will qualify for a premium tax credit that will help lower your premium costs. By 2020’s FPL numbers, this meant that a family of four whose combined household income was between $26,200 and $104,800 would qualify for a premium tax credit.
Depending on your income, you may also qualify for Cost Sharing Reductions (CSR), which are special savings built-in to Silver-level Marketplace plans for people who earn between 100 and 250% of the federal poverty limit. These CSRs limit and reduce out-of-pocket costs like copays and deductibles.
Remember that if you are married and do not file taxes jointly with your spouse, you will not be eligible for any subsidies or CSRs in the Marketplace.
Health Sharing Plans Open Enrollments
Since these plans are not par of the system there is not an open enrollment, you can do it any time you qualify.
Medicare Supplement Open Enrollment
This is actually called Medicare Annual Election Period or MEDICARE AEP which is normally Oct 15th to Dec 7th each year, but if you have a medicare supplement of a plan https://medigap.plus you can change any time of the year if you qualify!