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AARP Answers: ACA Insurance and the Coronavirus

The latest on special open enrollment periods, life-changing events and more

Book for the Affordable Care Act

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I need health insurance now. Can I sign up for a plan under the Affordable Care Act (ACA)?

Yes. On March 23, the 11th anniversary of the signing of the Affordable Care Act (ACA), President Joe Biden announced a second extension of a special open enrollment period for the HealthCare.gov federal marketplace until August 15. People who need to sign up for the first time or want to upgrade their coverage can do so during this period. In a recent report, the Kaiser Family Foundation estimated that about 15 million Americans may need to shop for coverage on the ACA marketplaces. AARP research estimates that 5.5 million adults between 50 and 64 do not have access to coverage through their job or a public program.

AARP had sent a letter to Congress last spring asking for a nationwide special open enrollment period: “Access to affordable health care coverage is more important now than ever,” said Nancy LeaMond, AARP’s executive vice president and chief advocacy and engagement officer.

It’s also important to note that those who have lost their jobs and their incomes may qualify for Medicaid — a free or low-cost health program that enrolls applicants year-round.

What if I live in a state that has its own health insurance marketplace?

You can still probably enroll in an ACA plan. After the U.S. Department of Health and Human Services announced the first extension of the special enrollment period until May 15 for the federal marketplace, the states with their own ACA exchanges did the same thing. Check with your state marketplace to find out the time period for your special enrollment period.

Will my ACA plan cover coronavirus care?

The symptoms of COVID-19, the illness caused by the new coronavirus, include:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

The majority of people who get sick with COVID-19 have mild symptoms and are able to recover at home. Some cases, however, are more severe and may require medical attention.

In those instances, all ACA plans are required to cover emergency services and hospitalization. Policyholders, however, may have out-of-pocket costs from coronavirus-related care, depending on their individual plans and any copayment and cost-sharing responsibilities.

I have already tested positive for the coronavirus. Can a health plan deny me coverage?

No. All ACA plans must cover treatment for preexisting medical conditions. And plans can't terminate coverage due to a change in health status, “including diagnosis or treatment of COVID-19,” according to HealthCare.gov.

What will an ACA plan cost me?

There are four types of plans in the ACA marketplace, and your monthly premium and out-of-pocket costs depend on your plan:

  • Bronze: Lowest monthly premium; highest out-of-pocket costs. Deductibles can be thousands of dollars a year.
  • Silver: Moderate monthly premiums; moderate out-of-pocket costs.
  • Gold: High monthly premiums; lower out-of-pocket costs; low deductibles.
  • Platinum: Highest monthly premiums; lowest out-of-pocket costs; lowest deductibles.

Depending on your household income, you may also be eligible for a subsidy to lower your monthly premium, as well as assistance to help cover out-of-pocket costs A two-year increase in ACA subsidies is included in the American Rescue Plan Act signed into law on March 11. Under this law, for two years, people with incomes above 400 percent of the federal poverty level ($51,520 for an individual) will qualify for subsidies so they will not have to pay more than 8.5 percent of their annual income for their health care premiums.

Editor's Note: This story is updated periodically with new developments. Check back regularly.