The Affordable Care Act (ACA) is open for business again.
In light of COVID-19, President Joe Biden established a special open enrollment that allows anyone, for any reason, to enroll in an ACA insurance plan from Feb. 15 through May 15. Typically, if people want ACA insurance, they have to enroll by mid-December of the previous year except when they have a qualifying life event like losing a job or having a child.
The special enrollment period will allow someone who missed that deadline to enroll in a plan even if nothing has changed in their life. The special enrollment, however, is only guaranteed for the 36 states whose ACA plans are hosted on the federal marketplace, Healthcare.gov.
Fourteen states and Washington, D.C. run their own platforms and can make up their own enrollment rules. Many of those states, though, are mirroring the same special enrollment or offering some kind of extension. You can check what your state is doing here.
One feature that is unique to this special enrollment period is that people who currently have health insurance through the ACA can make changes to their plan for any reason as well.
“So if you enrolled for 2021 coverage during the regular open enrollment period, but you’re not satisfied with your choice, you can change your plan until May 15,” said Melanie Hall, executive director of the Family Healthcare Foundation.
The reason there’s a time limit to the usual ACA open enrollment and this special enrollment period is to “encourage people to secure insurance plans for year-round coverage and not just when they need care. It protects the stability of the market,” said Jason Alford, vice president, sales and business development at Health First Health Plans.
To sign up for insurance through the ACA marketplace, visit Healthcare.gov. If your state runs its own ACA platform, you’ll be directed to that site from the federal page.
To qualify for insurance through the ACA, you must:
● Live in the United States
● Be a U.S. citizen or a U.S. national
● Not have Medicare
Insurance through the ACA isn’t free except for people with very low incomes, but 85% of people qualify for subsidies that reduce the cost of the monthly insurance premium and 70% receive other cost-sharing reductions like discounts on deductibles and copays, Hall said. Tax credits are available to anyone earning up to 400% of the federal poverty level — $51,520 in 2021.
Tips for choosing an ACA plan
There are three main ACA plans: bronze, silver and gold. Bronze has the lowest monthly premium, but you must pay more for your healthcare costs. Silver is in between and gold has the highest monthly premiums, but insurance covers more of your costs. While it can be tempting to go with the plan with the lowest premium, that might not always work in your favor if your out-of-pocket costs are high.
Before you choose a plan, Alford recommends ensuring that your medical providers are included in the plan’s network and that your plan has robust prescription drug coverage if you take a lot of medication. You can search by your zip code for a list of in-network providers.
One other very important step, Hill said, is to read the specific Summary of Benefits for each plan. You’ll find them under the Plan Documents listed for every ACA plan.
“This list goes beyond just deductibles and copays,” Hill said. “It also specifically spells out your responsibility for services like labs, imaging, and hospital stays.”
That will give you a much better idea of how much the plan will cost you and which one best meets your needs.
If you later get a job that offers employer-sponsored health insurance, you can cancel your ACA insurance. You also can still keep your ACA insurance even if your job offers insurance. But if your employer’s insurance option is considered both affordable — less than 9.8% of your household income for employee-only coverage — and meets certain standards, you will lose out on any ACA tax credits, Hill said.
“Typically, it works out best to enroll in employer-sponsored insurance since the employer often pays a portion of the cost," she said. "But you can always look at the ACA marketplace and compare it to the costs of your employer plan."
Read more on the topic from our Healthcare section