Has it been a year already? Healthcare open enrollment is approaching faster this year, than any other year, and choosing a health plan is very important. A lot has changed since last year because of COVID-19 and it’s critical that you have some form of health insurance for the coming year.
Biggest 2021 Open Enrollment Updates
- Insurance Rate Increases Are Going To Be Lower Than Previous Years
Good news! From an insurance standpoint, the average rate increases appear to be lower than previous years.
- There Are More Insurance Providers in The Marketplace
Another upside is the number of health insurance carriers offering plans is increasing. On average, marketplaces are offering 4.5 health insurance carrier options per state up from 3.5 in 2018 and 4.0 in 2019. That means more options for you to choose from!
- You May Qualify for Subsidies If You Recently Lost Your Job or Took a Pay Cut
If you are one of the fortunate ones that have not been financially impacted by the COVID-19 pandemic (still employed with no loss of income), open enrollment will be relatively similar to last year, but with some more options. If you have lost your job or have had significant income reductions due to the COVID-19 economy and have a preexisting condition, Affordable Care Act (ACA) subsidies may provide some financial relief.
The Basics of Affordable Care Act (ACA) for 2021
What ACA Plans Cover
Remember, ACA compliant health insurance plans covers:
- All 10 essential health care benefits
- All pre-existing conditions
- Provides unlimited coverage after meeting your deductible copay and out-of-pocket (OOP) costs
- ACA provides income-based subsidies
Remember that ACA plans are the best options for people with pre-existing conditions or if you qualify for subsidies. If that’s not you, check out our post on alternative health plans.
Qualifying For Subsidies
ACA endorsed enrollment systems will calculate whether or not you qualify for subsidies. Uncovered’s partnership with Health Sherpa will help calculate your potential subsides when you enter your estimated income for 2021 (Bonus! Through Health Sherpa, you’ll be able to calculate your subsidies in just minutes vs the typical 25+ minutes through healthcare.gov.) The calculator will determine if you qualify for a health insurance subsidy and how much that subsidy will be or if you qualify for Medicaid, which in many states requires little or no monthly premiums*
To illustrate how powerful these subsidies can be, we calculated a Michigan family of four making $63,000 a year. They lost a third of their income during the pandemic, reducing their family income to $41,500. When reapplying for a health plan, they became eligible for subsidies which reduced their monthly premiums from $1,100 to $108 per month!
*Note: if your estimated 2021 income ends up higher by year end the government has the right to recoup apportion or all of the granted subsidies difference. The 2021 results will vary due to new 2021 premium and plan offerings.
Depending on Where you Live, The Process of Signing Up for ACA Will Vary.
For most states, you can begin the ACA sign up process directly through Health Sherpa to find the plan that’s right for you. However, if you live in one of the states in the list below, you must sign up for ACA through a state-specific process, since these states are “State-based Marketplaces” or SBM’s.
Find your state below and click the link to start the process of signing up for ACA:
|DISTRICT OF COLUMBIA||https://dchealthlink.com/|
|ALL OTHER STATES||https://www.healthsherpa.com/|
For information about the difference between State-Based Marketplaces, State-based Marketplace-Federal Platform and Federally-facilitated Marketplace, see below:
- State-based Marketplace (SBM): States running a State-based Marketplace are responsible for performing all marketplace functions for the individual market. Consumers in these states apply for and enroll in coverage through marketplace websites established and maintained by the states.
- State-based Marketplace-Federal Platform (SBM-FP): These states are considered to have a State-based Marketplace, and are responsible for performing all marketplace functions for the individual market, except that the state will rely on the federal Healthcare.gov website for eligibility and enrollment functions. Consumers in these states apply for and enroll in coverage through Healthcare.gov.
- Federally-facilitated Marketplace (FFM): In a Federally-facilitated Marketplace, HHS performs all Marketplace functions. Consumers in FFM states apply for and enroll in coverage through Healthcare.gov.
Questions To Ask Yourself Before Picking A Plan
Before choosing a plan, make sure to 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?
If you are concerned about being able to pay for the higher out of pocket costs, there are other actions you can take:
- Talk to your doctors and providers about payment plans
- Ask the hospital for financial assistance and/or check with patient access foundations (e.g. Patient Advocate Foundation) and disease state foundations (e.g. American Cancer Society). They may all be able to assists with your bills
- Instead of avoiding getting medical treatment because of financial strain, consider opening an extra credit card for medical expenses that can cover up-front costs, that you can pay off later.