Update to below content: in early 2021, the Biden administration created a special ACA open enrollment period to help fight the COVID-19 pandemic and a qualifying life event is not needed to enroll in an ACA plan.
The Affordable Care Act lives on, and with a Biden administration taking over in January, it’s safe from meeting its demise through executive or legislative branch changes until January of 2025, at least. There is currently an open Supreme Court case with the plaintiffs aiming to overturn the ACA, but a majority of the 9 current Supreme Court justices have signaled their support for upholding the law, so it is likely to stay in tact. Even if the law were to be overturned, there would be a long exit ramp for those who were insured through the health exchange. In other words – don’t be afraid to sign up.
Registration for ACA plan coverage in 2021 has already started at healthcare.gov, and the deadline to sign up within the open enrollment period is December 15th in most states. If you do not have health insurance, I would strongly recommend signing up for an ACA plan. I’ve provided resources and answers to a number of common questions about ACA enrollment below.
What’s New for the Affordable Care Act in 2021?
Voters in Missouri and Oklahoma passed Medicaid expansion ballot measures in 2020, and those states bring the total number of states with Medicaid expansion up to 38 (+DC) in 2021 (though Missouri has until March 1st of 2021 and Oklahoma has until July 1st of 2021 to launch). The income threshold to be eligible for Medicaid expansion will be roughly $1,400 for a single individual and $2,950 for a family of four.
For those who do not qualify for Medicaid, there is still a good chance that you will be eligible for a subsidized private health insurance plan. According to the U.S. Centers for Medicare & Medicaid (who runs the ACA), plan prices, on average, will decrease in 2021 (as they had the 2 prior years as well),
The average premium for the second lowest cost silver plan (also called the benchmark plan) dropped by 2% for the 2021 coverage year…Three years of declining average benchmark plan premiums combine to deliver an 8% premium reduction across HealthCare.gov since the 2018 coverage year.
Nine out 10 Americans who enrolled in a healthcare.gov plan received subsidies last year, and most Americans will be able to find plans with subsidized monthly premiums of less than $75. The subsidy threshold for 2021 is based on a multiplier of 4X the federal poverty levels for 2020, with the upper income threshold at $51,040 for an individual and $104,800 for a family of four. Four states – Four states – California, Massachusetts, New Jersey, and Vermont – also use state funds to supplement the federal subsidies.
Additionally, federal cost-sharing reductions (aka “CSR’s”) are available to reduce the out-of-pocket costs for eligible enrollees. Once reduced out-of-pocket maximums are met, costs are covered 100%. CSR’s are available on noted “silver” plans only.
Consumers will also have more plan choices:
The percentage of HealthCare.gov enrollees with access to only one issuer is decreasing from 29% in 2018 to 4% in 2021 and more than three quarters of HealthCare.gov enrollees will have access to at least three issuers in 2021.
It is worth noting that state unemployment benefits count as income when you apply for both marketplace or Medicaid coverage. The CARES Act had explicitly excluded the now-expired additional $600 per week in unemployment benefit payments from counting toward eligibility for Medicaid, but not for marketplace plans.
With a new Congress and President taking over, my sense is that we will see additional enhancements to the ACA in 2021.
What Does the ACA Cover?
Aside from pre-existing condition coverage and coverage of a certain percentage of your total health care costs (up to 100%) once your deductible is met, and 100% once your out-of-pocket maximum is met, ACA plans all cover the following 10 essential health benefits at any time:
- 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)
What are the Open Enrollment Dates?
For the 38 states that use the federal healthcare.gov site, plus CT, ID, MD, VT, WA, open enrollment is Nov. 1 – Dec. 15, 2020. Eight states (+DC) have their own exchanges and longer open enrollment periods. They are as follows:
|State:||Jan. 1, 2021 Start Effective Deadline:||Feb. 1, 2021 Effective Deadline:|
|California:||11/1/20 - 12/15/20||12/16/20 - 1/31/21|
|Colorado:||11/1/20 - 12/15/20||12/16/20 - 1/15/21|
|Massachusetts:||11/1/20 - 12/23/20||12/24/20 - 1/23/21|
|Minnesota:||11/1/20 - 12/22/20||-|
|Nevada:||11/1/20 - 12/31/20||1/1/21 - 1/15/21|
|New Jersey:||11/1/20 - 12/31/20||1/1/21 - 1/31/21|
|New York:||11/1/20 - 12/31/20||1/1/21 - 1/31/21|
|Rhode Island:||11/1/20 - 12/31/20||-|
|Washington DC:||11/1/20 - 12/31/20||1/1/21 - 1/31/21|
It’s also worth noting that you may be eligible for a special enrollment period with a qualifying life event. There are a number of insurance options for newly uninsured individuals, including ACA plans, outside of the open enrollment period.
Where do I Enroll?
Healthcare.gov. If you’re in one of the states (+DC) with its own marketplace, you will be redirected from there.
If I Currently Have a Plan, Do I Need to Sign Up Again?
If you currently have a plan, it is strongly recommended that you log in to review your options for next year and either renew or switch plans. Significant changes in plans are expected with all of the chaos surrounding the markets (insurers don’t like chaos). Additionally, premium subsidies may change based off of your income and the plans you choose. You will want to update your income and household information appropriately.
Who Should Sign Up for a Marketplace Plan?
Everyone who does not have employer sponsored insurance (either directly or through a family member, including your parents, if you are under age 26), Medicaid, CHIP, or Medicare.
Why Should I Sign Up for a Marketplace Plan?
Because your health and financial solvency is at stake. Even the healthiest among us are just one unforeseen event or imperfect gene away from medical costs that could bankrupt us. Additionally, marketplace plans provide subsidies to roughly 90% of everyone who purchases a plan on the exchanges. If you buy insurance outside of the exchanges, you will not receive subsidies.
What do I Need to Sign up for a Plan?
The Centers for Medicare and Medicaid Services (CMS) has put out a checklist of the information needed for marketplace applications.
Where Can I Get Help Signing up for a Plan, if Needed?
If you have questions about signing up or want to talk through your options with a trained professional, call 1-800-318-2596 or visit https://localhelp.healthcare.gov/#/.
Let’s get everyone enrolled at healthcare.gov!