Obamacare Open Enrollment Has Started—9 Things to Know

Mattie Quinn
·11 min read

Amid the coronavirus pandemic, many people have realized that access to health care is more important than ever. Despite the Trump administration’s many attempts to overturn the Affordable Care Act, or Obamacare, the program is still in effect. On November 1, open enrollment began for Affordable Care Act coverage starting January 1, 2021. This means people who are not insured through their employers, partners, or other sources have until December 15 to select an insurance plan on their own, either through the insurance marketplace or private companies. Deciding on health care is a confusing exercise under normal circumstances, unless you’re a seasoned pro when it comes to the health insurance marketplace (which very few people are, don’t worry). But the political turmoil surrounding the Affordable Care Act makes the situation this year even more perplexing than usual.

To make it all a little easier, we’ve highlighted what you need to know during this open-enrollment period. Here are nine things to keep in mind as you wade your way through Obamacare open enrollment for 2021.

1. First things first, know that the marketplace is open.

It may sound simplistic, but health care experts insist that many of the doom-and-gloom headlines around the Affordable Care Act have scared people off from the marketplace altogether. Experts say that many people believe that the ACA did actually get repealed at some point, or that the marketplace will be going away. This summer, in the latest of a long string of attempts to repeal Obamacare, the Trump administration and several Republican state officials asked the Supreme Court to overturn the ACA. The court likely won’t rule on this case until the summer of 2021, meaning the ACA is still currently in effect, according to the nonpartisan Kaiser Family Foundation (KFF). These ongoing political battles have caused confusion about the status of the ACA. But rest assured, you can sign up for insurance if you would like.

“Yes, you can enroll, Obamacare is not dead,” Caitlin Donovan, director of outreach and public affairs for the National Patient Advocate Foundation, tells SELF.

2. Open enrollment on the federal marketplace only lasts from November 1 to December 15.

If you’re looking for a plan on the marketplace (i.e., you’re not getting health insurance through your employer and you’re not eligible for Medicare or Medicaid), you’ll use the enrollment website Healthcare.gov; the Spanish-language version, CiudadoDeSalud.gov; or a state website to sign up for a plan. While the deadline to enroll on a national plan through Healthcare.gov and CiudadoDeSalud.gov is December 15, 14 states and Washington, D.C., have their own marketplaces, which abide by their own rules and may have different deadlines. The plan you choose during this period will go into effect on January 1, 2021.

3. You may actually still qualify for 2020 coverage.

Many people lost their jobs and employer-sponsored health coverage during the pandemic. If this happened to you, then you may qualify to sign up for health coverage for the remainder of the year through the Special Enrollment Period. People who experienced certain life changes that affect their insurance status or needs within the past 60 days, including marriage, divorce, the birth of a child, or loss of health insurance, can apply using this rule. People who believe they will lose their insurance in the next 60 days may qualify too. (This applies to dependents who age out of their parent’s plan, for example.) People who lost their insurance but couldn’t enroll in the marketplace due to issues relating to COVID-19 may also qualify after the 60-day period.

4. Consider how the coronavirus may change your insurance needs.

As COVID-19 cases surge throughout the country, many people are understandably wondering whether they’ll have large medical bills if they contract the virus. First, it’s important to know that all ACA plans cover treatment for preexisting medical conditions. In other words, your insurance will apply to the cost of COVID-19-related treatments next year even if you were diagnosed in 2020. Further, your coverage can’t be terminated just because you develop a new condition, such as COVID-19.

People who experience financial hardship due to COVID-19 can ask their insurance company about extending the grace period for their monthly payment (also known as a premium). Individuals who don’t receive federal financial assistance with their premiums generally can pay up to a month late without having their insurance terminated. People who do receive financial assistance usually get a three-month grace period for late payments. The grace period varies by state law, so you will need to call your insurance company for details. You may also qualify for a cheaper plan if your income changed during the pandemic. (You can update your application with recent income information using your Healthcare.gov account to see if cheaper plans are available.)

If you don’t have insurance, now is a good time to research affordable plans. There are no laws requiring hospitals to waive COVID-19 treatment costs for uninsured patients, so if you get coronavirus in the future, you may have to pay all the associated medical bills, according to KFF.

Insurance companies vary in coverage, so you’ll want to call and ask about their specific benefits if anything is unclear. Due to the pandemic, many doctors started offering virtual visits using Zoom or even FaceTime. Most insurance companies cover some form of telehealth, but again, you’ll need to check with your specific provider about what is covered.

5. ACA insurance options may be a bit more affordable than last year.

There’s a chance you could find good coverage for a lower price this year. ACA premiums are dropping throughout the country, according to an October 2020 report from the Department of Health & Human Services. Monthly premiums have increased since the ACA was introduced in 2017, but the average 27-year-old and family of four can both find a silver plan (the second cheapest) for 2% less next year compared to 2020, according to the report. So, not a ton, but every little bit helps.

For background, the marketplace includes four tiers of plans that reflect their monthly cost: bronze, silver, gold, and platinum. All plans are required to cover what the Obama administration dubbed “essential health benefits.” These include a yearly checkup, a well-woman visit, and mental health services. Bronze plans are the lowest-cost plans per month, but they have the highest deductibles (how much you have to pay for services before your insurance kicks in), so you’ll pay more out of pocket. Silver, gold, and platinum plans, on the other hand, have higher monthly costs but cover more services.

6. You may be eligible for financial assistance that lowers your insurance costs.

Depending on your income level, you might qualify for insurance assistance that keeps your out-of-pocket payments as low as possible. For instance, people who make between 100% and 400% of the federal poverty level ($12,760 to $51,040 for one person, and $26,200 to $104,800 for a family of four) and don’t qualify for other forms of insurance may receive premium tax credits to lower the cost of their premiums, according to KFF. Those with silver plans who qualify for premium tax credits and make between 100% and 250% of the federal poverty level specifically ($12,760 to $31,900 for one person, and $26,200 to $65,500 for a family of four) may be eligible for additional cost-reducing subsidies.

It’s estimated that more than 5.3 million people who shop on the exchanges qualify for these subsidies. You can find out if you’re eligible for a lower-cost plan or insurance assistance on the HealthCare.gov website (or your state’s insurance website if that’s the exchange you need to use).

7. You should always shop around before buying in order to make an informed decision.

Experts say that because there has been such uncertainty and change in the marketplace, it’s important to not auto-enroll in whatever plan you had last year—after all, you may qualify for a cheaper plan this year. It’s also not uncommon for insurers to tweak plans from year to year, and that could impact anything from your prescription drug coverage to your primary care doctor no longer being in-network.

“It’s really important to log on and update your information because you really could be getting a plan that’s cheaper and a bit better for you,” Erin Hemlin, director of health policy and advocacy for Young Invincibles, tells SELF.

This is especially true if your income or health care needs changed from last year, because you’ll want to adjust your plan accordingly. For example, Donovan warns against a bronze plan if you have a chronic condition or expect to make more than a few trips to the doctor in 2021, since these plans don’t offer as much coverage.

If you’re young and reasonably healthy, a bronze plan might make sense for you since it covers essential health benefits with the lowest possible premiums—but there’s no way to know until you do your research.

8. When in doubt, there are informed navigators to help you consider your options.

Navigators help people maneuver the landscape of Healthcare.gov and the plan that works best for their lifestyle. Best of all, using one is free, and you can search for specific languages or interpretive services as necessary.

Turning to a navigator is especially important if you don’t think you qualify for subsidies or, on the flip side, you’re not sure if you qualify for Medicaid or should be signing up for a plan on the marketplace. Navigators will help you parse through your projected income for next year to make sure you’re getting all of the assistance you qualify for.

If you’re not sure where to find a navigator in your area, visit Healthcare.gov’s Find Local Help tool. The pandemic has changed many in-person services, so contact navigators about conducting virtual sessions.

9. There is no federal penalty for going without coverage.

Initially, people who went without health insurance had to pay a tax penalty after the ACA passed. This was known as the individual mandate.

This aspect of Obamacare was unpopular because people felt forced into buying coverage. In theory, more healthy people would sign up for insurance because of this mandate, ultimately offsetting costs for people who required more health care. However, economists now say the mandate didn’t affect insurance sign up, The New York Times reported.

In 2017 the Trump administration removed the individual mandate, but certain states created their own versions. You can check with your state’s department of health care services to learn more.

You may worry that an Affordable Care Act plan doesn’t make sense for you financially. Keep in mind that an off-exchange plan could be a better fit—you don’t just have to automatically go without insurance. Health insurance companies can sell plans directly to you through their websites, and while those plans are likely going to be similar to what you see on the exchange, it’ll give you a broader look at what’s out there.

In some cases, especially given the financial effects of the pandemic, it might be incredibly tough to figure out how to budget for insurance. This may sound obvious, but it’s really worth emphasizing that it’s best to have insurance if it’s even remotely possible. Astronomical medical debt can follow people for decades, particularly when COVID-19 cases are at an all-time high in our country. Again, there’s no federal financial support for COVID-19 treatment, so you may have to pay the full cost if you get sick. (Although there are some methods of negotiating high medical costs that may help.) It’s not right or fair that insurance can cost so much in this country, but it can still be so useful that experts advise getting it nonetheless whenever possible.

“No matter how much the premiums cost, if you have an emergency and don’t have insurance, you could end up at a hospital that charges $24,000 for a sprained ankle. It’s always better to have insurance,” Donovan says.

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Originally Appeared on SELF