You usually only have six weeks to make a decision on an individual health insurance or Affordable Care Act (ACA) exchanges plan in most states.
You can sign up for health insurance on your state’s health insurance exchange or individual marketplace only during an annual open enrollment period, unless you have a “qualifying life event.” Those events include getting married or having a baby.
If you’re buying health insurance on your own, you have several options for purchasing a policy:
- From your state’s health insurance marketplace — check Healthcare.gov to find yours
- Directly from a health insurance company
- From websites like Insure.com that offers health insurance quotes from multiple carriers
- From a health insurance agent
- You can enroll for health insurance on your state’s marketplace or individual marketplace only during the annual open enrollment period.
- Marketplace open enrollment only applies to health insurance programs, it is not for auto, life insurance or long-term care insurance.
- If you miss the opportunity to sign up for a plan during open enrollment, you will have to wait for a year or you should qualify for a special enrollment period.
Here’s what you need to know for the open enrollment period for 2021 individual and family health insurance plans.
1. Special enrollment period in 2021 is until Aug. 15
President Joe Biden signed an executive order to launch a special enrollment period to Aug. 15, 2021. During that time, you can sign up for an ACA plan.
Usually, most Americans only have between Nov. 1 and Dec. 15 to get a plan. Some states have longer open enrollment periods, but again you’re limited to that time unless you qualify for a special enrollment period. You may qualify for a special enrollment if you lost your job or had a child.
However, with the executive order, Biden launched a special enrollment period, so you don’t need a qualifying event to get a plan.
Biden’s order only pertains to the 36 states that use the ACA federal marketplace. The other states that run their own marketplace will likely also launch their own special enrollment periods.
People who qualify for Medicaid or the Children’s Health Insurance Program (CHIP) can enroll at any time of the year. These are state-federal programs for people with limited incomes or disabilities.
2. You’re not required to have health insurance in most states
The ACA once required nearly all Americans to have health insurance. However, Congress eliminated the individual mandate penalty in 2017.
So, though the individual mandate is technically still on the books, the penalty is not. You won’t get whacked at tax time if you don’t have health insurance.
However, a handful of states have implemented their own individual mandates. Here is who has an individual mandate in 2021:
- District of Columbia
- New Jersey
- Rhode Island
3. Open enrollment is the time to make changes to your current plan
Open enrollment is your annual chance to make changes to your health insurance.
Here’s what you can do during open enrollment:
- Renew your current individual/family health insurance plan.
- Choose a new health insurance plan through the marketplace in your state or through private insurance.
If you’re currently enrolled in a marketplace health insurance plan, it will automatically renew if it’s still being offered. However, the plan may make changes to its provider network, copays, co-insurance and drug coverage. Your plan must send you a notice of any changes it will make for 2021.
Take time to read the notice to see what it means for you. Make certain your doctors and preferred hospital are still in your network.
Getting care outside of your network will cost you more. Preferred Provider Organization (PPO) plans allow out-of-network care, but you pay more. Health Maintenance Organization (HMO) plans, meanwhile, don’t usually cover any out-of-network care. In that case, you’ll have to pay for all of the care yourself.
Your prescription drug coverage also could change. The plan may no longer cover the drugs you take to manage your chronic conditions. It’s important that you check your plan’s drug benefits for 2021 before you allow it to renew. You may need to find a different plan for your needs and now’s the time to do it.
Health plans must provide an online link to the list of drugs they will cover, known as formularies.
4. Marketplace open enrollment is only for health insurance
If you qualify for employer-sponsored health insurance, you’ll likely want to buy health insurance through your employer. Employer-sponsored health plans are usually less expensive than individual health insurance. That said, if you qualify for subsidies based on your income, you may find an inexpensive plan on the ACA exchange.
Many states offer financial help for people with income below 400% of the federal poverty limit. You can find out more about these subsidies below.
Open enrollment is not for auto, life insurance or long-term care insurance. Those are completely separate products that you can buy on your own any time of year.
It’s also not for Medicare. The fall open enrollment period for Medicare is Oct. 15 to Dec. 7, 2020.
5. If you miss open enrollment, you may have to wait for a year to sign up
You won’t be able to sign up for coverage if you miss open enrollment unless you qualify for a special enrollment period.
Here’s what might trigger a special enrollment period:
- Birth or adoption of a child
- Death of a spouse or partner that leaves you without coverage
- Your spouse or partner, who has you covered, loses his/her job and health insurance
- You lose your job and with it your health insurance
- Your hours are cut making you ineligible for your employer’s health insurance plan
- You are in an HMO and move outside its coverage area
6. Plan choices in individual insurance are based on costs and plan design
Plans in the health insurance marketplace are divided primarily into four categories:
- Bronze — lowest premiums, but highest out-of-pocket expenses for health care services
- Silver — higher premiums than Bronze, but higher out-of-pocket costs than Gold or Platinum
- Gold — higher out-of-pocket costs than Platinum, but lower premiums than those plans
- Platinum — highest premiums, but lowest out-of-pocket expenses for services
The metal level indicates how much cost-sharing they require. Cost-sharing includes deductibles, copays and co-insurance that you must pay until you reach your out-of-pocket maximum limit.
Bronze plans have the highest deductibles and other cost-sharing. That means more out of pocket costs when you use healthcare services. Silver plans have lower cost-sharing than bronze and gold plans even lower than silver. Platinum plans have the lowest deductibles and copays, etc.
Generally, the more you pay in premiums the lower your cost-sharing.
In a 2020 report, eHealth estimated that premiums for individual coverage for a single person was $456 in 2020, which was a slight increase over 2019.
The average monthly premiums for individual coverage by metal level, according to eHealth, were:
- Bronze — $448 (an $8 average increase from 2019)
- Silver — $483 (a $2 average increase from 2019)
- Gold — $596 (a $27 average decrease from 2019)
- Platinum — $732 (a $26 increase from 2019)
For family coverage, the average monthly premiums were:
- Bronze — $1,041 (a $39 average decrease from 2019)
- Silver — $1,212 (a $32 average increase from 2019)
- Gold — $1,437 (an $11 average increase from 2019)
- Platinum — $1,610 (an average $150 increase from 2019)
The most popular plan in the individual market is Bronze, eHealth said. Here’s the percentage for each type:
- Bronze — 42%
- Silver — 34%
- Gold — 14%
- Platinum — 2%
Bronze and Silver plans have deductibles that can classify them as high-deductible health plans (HDHPs). People with an HDHP are usually eligible for a health savings account (HSA), which lets them save for future health care costs tax-free. eHealth estimated that 22% of ACA plans are connected to HSAs.
Meanwhile, you’ll also want to compare benefit plan design. Benefit plan design involves things like your provider network, where you can get care and whether you have to get referrals to see specialists.
The most common type of benefit plan design in the ACA marketplace is a health maintenance organization (HMO) plan. HMOs make up nearly half of ACA plan. Here’s the break down:
- HMOs — 49%
- Exclusive provider organization (EPO) — 33%
- Preferred provider organization (PPO) plans — 16%
The major difference between HMOs, EPOs and PPOs is that PPOs don’t require referrals to see specialists and allow you to get out-of-network care, though at a higher cost than in-network care. EPOs also don’t usually require referrals to see specialists, but only pay for in-network care. HMOs require both in-network care and that you get referrals to see specialists.
Which plan is right for you depends on your preferences and how much you’ll need healthcare in 2021. If you go to doctors frequently to help manage a chronic condition, you likely want a plan with lower copays and deductibles. If you’re healthy, you may be better off signing up for a plan with lower premiums but higher costs when you use your insurance. Of course, it’s a gamble, because you never know what’s going to happen.
Health insurers also offer plans outside the marketplace that have a variety of benefit choices. You can get a plan outside of the marketplace, but you won’t be eligible for subsidies to help you pay for care.
7. Many ACA premiums are lower in 2021
After years of skyrocketing premiums, ACA plan member costs will decrease for many plans.
The exact premium you pay depends on factors, including income, your state and the plan type. The Centers for Medicare and Medicaid Services said the average ACA federal exchange plans premiums in the second lowest cost Silver plan will decrease by 2% for a 27-year-old in 2021. That comes after a 4% decrease in 2019.
CMS said Iowa, Maine, New Hampshire and Wyoming will see decreases of 10% or more. North Dakota, however, will have an average increase of 10% or more.
J.A. (Jim) Connell, a professor at the University of Montevallo in Montevallo, AL, said reduced regulations and more insurance company competition has led to stable premiums in the marketplace. Connell added that Congress removing the individual mandate tax penalty has led to health insurers needing to “compete harder for customers.”
“Healthier individuals can enroll in less expensive plans and insist on larger networks for possible treatment. They are purchasing fewer units of insurance coverage, but that is a consequence of individuals being allowed to make their own health insurance choices,” said Connell, adding that states with higher premiums frequently have fewer insurance options.
While premiums may decrease, deductibles are on the rise. Deductibles are what you have to pay before your health plan starts paying for health care services.
Here are the median individual deductibles for 2021:
- Bronze — $6,992 (an increase from $6,755 in 2020)
- Silver — $4,879 (an increase from $4,630 in 2020)
- Gold — $1,533 (an increase from $1,432 in 2020)
CMS didn’t provide an estimate for Platinum plans. Those plans, which only make up 2% of ACA plans, usually have low deductibles.
Not all plans will be cheaper in 2021, so it’s still important to shop around to find the right plan for you.
8. All health plans must cover 10 essential benefits
The health plans, no matter the level, must provide some coverage for at least 10 essential benefits. They are:
- Outpatient care including chronic disease management
- Emergency care
- Pregnancy and newborn care
- Mental health and substance abuse services
- Prescription drugs
- Rehabilitation services and devices
- Lab tests
- Preventive and wellness services
- Dental and vision care for children
The level of coverage for these services can vary. All the plans in the marketplace must provide consumers with a brief, understandable description of what they cover and how their plan works. The Summary of Benefits and Coverage (SBC) must be posted on the plan’s website. Check out the SBCs for the different plans you are considering. This is a good way to compare plans and benefits.
9. Your family size and income determines your eligibility for tax credits
You may qualify for a premium tax credit which is based on income and family size. To qualify, your family income must fall between 100% and 400% of the federal poverty level (FPL).
If you qualify, the credits can be applied to your monthly insurance premiums. If your income changes during the year and you no longer qualify for the credits when you file your taxes, you will have to repay.
Here are the 2020 federal poverty level guidelines, which apply to 2021 coverage:
|Persons in Household||2020 federal poverty level for continental U.S.||Premium subsidy threshold (400% of federal poverty level)|
Those subsides can save you hundreds every month. For instance, CMS said a 27-year-old at 150% of the federal poverty level would pay on average $57 per month for the lowest cost Silver plan. That same person would pay $369 on average per month for the same plan without a subsidy.
Those subsidies are helping people keep their coverage. CMS estimates that enrollment in unsubsidized ACA plans dropped 9% between 2018 and 2019. Subsidized plan enrollment decreased by only 1% in that period.
Unsubsidized enrollment dropped signficantly in some states, including Iowa, which saw a 40% decrease between 2016 and 2019.
10. Catastrophic health plans offer low-cost alternative
An alternative to ACA plans is catastrophic health plans. These low-cost plans offer the same level of coverage as ACA plans. However, that comes at much lower premiums, but higher deductibles.
Catastrophic plans are only available to people under 30 and those who are facing hardships that would make affording another health plan possible.
eHealth estimated the average monthly premium was only $195 in 2020, so you can see how much more affordable those plans are compared to regular ACA plans.
However, catastrophic health plans’ deductibles, are much higher than other health plans. Catastrophic health plans’ deductible is $8,150, which is significantly higher than other plans. Once you reach your deductible in a catastrophic health plan, the plan covers the rest of your costs.
Frequently asked questions about open enrollment
When is open enrollment for health insurance 2021?
The open enrollment period for health insurance 2021 started on November 1, 2020, and concluded on December 15, 2020, for most states. However, the federal government has declared to re-open Affordable Care Act (ACA)marketplace until August 15, 2021, as special enrollment period.
What is Medicare open enrollment period?
Medicare open enrollment is a time when those who are eligible to enroll in Medicare can take the opportunity to switch coverage or change their plan. It is also known as the annual election period giving you the opportunity to make changes or stay put if it suits your needs best.
When is Medicare open enrollment?
What are the Medicare open enrollment dates for 2021? Medicare open enrollment begins on October 15 and ends on December 7 every year. During open enrollment period you can make changes to your Medicare coverage, and you can also enroll for a Medicare Advantage plan or Medicare Part D plan.
What are qualifying life events?
Qualifying life events are events that can open enrollment options for you. If your qualifying event is an involuntary reduction in pay or employment hours, it may open the door to a more robust plan with better coverage and lower monthly premiums. Qualifying life events include:
- Getting married
- Having a baby
- Moving to a new place
- Losing health insurance like Medicaid or Medicare Part D
How to get health insurance after open enrollment?
In order to purchase private health insurance after open enrollment you need a special enrolment period. This lasts 60 days from the date of qualifying life event, which is usually when someone gets married or divorced, has a baby, moves across state lines for work and more.
When does Obamacare open enrollment end?
In most states, the open enrollment window for 2021 health plans closed on December 15, 2020. The Biden administration has come up with a new way to make sure people have access to healthcare. The COVID/American Rescue Plan special enrollment period is open until August 15th and can be accessed through HealthCare.gov by anyone who qualifies for Affordable Care Act marketplace coverage.
When does open enrollment start for Obamacare?
Open enrollment for Obamacare starts on November 1st every year and open enrollment for 2022 coverage will start again on November 1, 2021.
How often is open enrollment?
Open enrollment is an annual event which takes place every fall. The open enrollment period typically lasts for 45 days and starts at the beginning of November in order to allow time for people to make informed decisions about their healthcare coverage options.
When does open enrollment end?
The open enrollment window closes on December 15th, but those of you living in states with extended open enrollment periods can get a chance to register even after it ends. Has Medicare Open Enrollment been extended for 2021? The Centers for Medicare & Medicaid Services (CMS) has decided to extend the Medicare open enrollment period till August 15th, so that people can avail themselves of the new savings.