En español | Open enrollment for the Affordable Care Act (ACA) health insurance marketplaces has begun, and most consumers have until Dec. 15 to choose the plans that will best meet their medical needs.
The open enrollment for coverage beginning in 2021 is happening in the midst of the COVID-19 pandemic and also as the U.S. Supreme Court is poised to hear arguments Nov. 10 in a lawsuit that could decide the future of the health care law.
"Sign up now if you need coverage for next year and we'll see what happens later,” says Karen Pollitz, senior fellow at the nonpartisan Kaiser Family Foundation. Pollitz says many consumers are confused about whether the law is still in force, which it is. The lawsuit challenging the constitutionality of the ACA was initially brought by Texas and includes 19 other states and two individuals. AARP joined 17 states and many advocacy organizations in arguing that the law is constitutional.
"We did a survey this spring and only 1 in 5 even knew that the ACA is still law,” Pollitz says. “I think people remain confused.” Even though the high court will hear arguments in the case Nov. 10, it will likely be sometime next year before the justices issue a decision.
In the meantime, a Kaiser Family Foundation report estimated that 27 million Americans could lose their work-related health insurance this year because of pandemic-related job losses.
"The ACA offers a really important safety net,” Pollitz says. “There really is affordable coverage for people, they just have to find out about it.” More than 11 million Americans currently get their health insurance through the federal and state marketplaces.
Though open enrollment ends Dec. 15 for consumers who get their coverage through the federal marketplace, 10 states and the District of Columbia have set later deadlines for when people can either make changes to their existing plans or sign up for the first time through state marketplaces:
- Minnesota, Dec. 22
- Colorado, Nevada, Pennsylvania and Washington, Jan. 15
- Massachusetts and Rhode Island, Jan. 23
- California, New Jersey, New York and Washington, D.C., Jan. 31
New for ACA plans in 2021
Average monthly premiums for ACA marketplace plans are expected to decrease by about 2 percent, according to the Centers for Medicare and Medicaid Services (CMS). This is a national average; actual premiums will vary based on the level of coverage and where you live.
CMS says the number of insurance plans available on the ACA marketplaces is also increasing. On the federal exchange, 22 more insurers will offer plans in 2021, for a total of 181 health-insurance companies. Only 9 percent of counties will have just one insurer available, compared to 24 percent of counties that had only one plan to choose from in 2020.
Two states that have been part of the federal marketplace — New Jersey and Pennsylvania — have left the federal system and opened their own state-run marketplaces. Consumers in those states have been notified of the change, which means they will have to enroll in those new marketplaces to maintain or change their coverage.
Most eligible for ACA subsidies
The vast majority of consumers who apply for coverage through the ACA are eligible for federal subsidies to help defray the cost of their monthly premiums. For 2021, four states — California, New Jersey, Massachusetts and Vermont — have decided to supplement the federal subsidies. These states all run their own marketplaces, so consumers should check with their individual states to determine if they qualify for the additional help with premiums.
The ACA provides two types of financial assistance: tax credits and cost-sharing subsidies. Eligibility is based on income, and historically more than 80 percent of people who get their insurance through the marketplaces are eligible for subsidies.
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For 2021, you are likely eligible for a tax credit for premiums if your annual income falls within these ranges: $12,760 to $51,040 for an individual and $26,200 to $104,800 for a family of four. You can also qualify for a cost-sharing subsidy if you sign up for a mid-tier silver plan and your income falls within these ranges: $12,760 to $31,900 for individuals and $26,200 to $65,500 for a family of four. (Marketplace plans come in four tiers — bronze, silver, gold and platinum — with the bronze tier having the lowest premiums but the highest cost-sharing for care, and the platinum tier having the highest premiums but the lowest cost-sharing.)
Healthcare.gov has a calculator to help you figure out if you qualify for a tax credit and/or cost-sharing subsidy and the amount you may qualify for.
How to get help
The ACA hotline, 800-318-2596, is available seven days a week, 24 hours a day. The law also provides helpers, called navigators, for people who need assistance enrolling. But funding for these navigators has declined in recent years. Not only are there fewer navigators, Pollitz says, but because of the pandemic most assistance is being provided online — not in person — and that is taking longer, so fewer people can get help.
"Don't wait to the last minute to review your coverage or enroll,” Pollitz advises. “There's a shortage of navigators, and the survey we did at the end of the last open enrollment period found that nearly 5 million people tried to get help but couldn't.”