U.S. Nationals Start Preparing, as Open Enrollment 2021 is Just Round-the-Corner

Open enrollment for 2021 individual and family health insurance plans available both in the exchange and off-exchange will commence from November 1, 2020, and end just over six weeks later on December 15, 2020, in most states. However, some states that have their own exchanges like California, Colorado, and Washington D.C. have permanently expanded their open enrollment period to allow its residents and small businesses a little relaxation for enrollment. The states that use a federally-run marketplace, around 35 states, will use Healthcare.gov as their exchange platform to enroll in health insurance plans in the autumn of 2020. This U.S. government portal proves to be a great resource for further open enrollment details.

This year the same schedule will be followed that was used for 2020 coverage in most states. Open enrollment in most of the states will end before the plans become effective in 2021, so enrollees will not get a chance to change their coverage after their plans become effective. Compared to the previous few years there is less turbulence and uncertainty in the individual health insurance market. Even the proposed rate increases for 2021 are modest, though that may change with more rate filings. Rate filings as of early July were made public in nine states, which amounted to an average proposed rate increase of about 2.6%.

Nearly in all states, health insurance carriers are including the CSR cost to the premiums of the Silver plan that is resulting in larger premium subsidies. Bronze and Gold plans are turning out to be affordable in many cases due to the disproportionately large subsidies that are offsetting the premium costs. Individuals who are not eligible for premium subsidies should opt for a non-silver plan or a silver plan that is sold outside the exchange. Because this will help them avoid paying premiums that come included with the CSR cost.

Individuals who qualify for government-funded programs like Medicaid, CHIP, or tribally-enrolled Alaska Natives and Native Americans can enroll in health insurance plans year-round. The states that have their own exchanges provide some flexibility in enrollment periods, so nationals need to check in with their state-run exchange for regional details. It needs to be understood that if individuals fail to enroll during the open enrollment period, then they will have to wait until they have a qualifying event to enroll.

Individuals who are planning to buy their own health insurance plan in the individual market this fall need to keep the following aspects in mind:fhealth


Individuals looking to buy health plans on or off-exchange have a little over six weeks to complete their enrollment process or make changes to their existing plans. In all the states that use healthcare.gov for enrollment, open enrollment will start on November 1 and end on December 15. There are 13 states that have their own exchanges and run their own enrollment platforms. These states have the flexibility to provide extra time before or after the regularly scheduled open enrollment period. Besides the 13 states, Pennsylvania will also have its own exchange in the fall of 2020, and even New Jersey may also have its own exchange in the fall of 2020.

Earlier most of the state-run exchanges have provided extensions to their open enrollment windows, but unless an exchange announces and extension prior to open enrollment, enrollees should complete the application process by December 15, and should not assume that will get some extra time.

• Washington DC open enrollment period is set from November 1 to January 31.
• California’s open enrollment period is also set from November 1 to January 31.
• Colorado’s open enrollment period is set from November 1 to January 15.
• Pennsylvania’s open enrollment period is also set from November 1 to January 15.

Once the open enrollment period ends, individuals will not have an opportunity to enroll or make changes to their coverage for 2021 without a qualifying event. If individuals’ health insurance carriers exit the market in their area at the end of 2020, then they will have a special enrollment period, which will be the first 60 days of 2021, during which they can pick a new plan.

Pennsylvania and New Jersey will have a New Enrollment Platform

Every state has a health insurance exchange, though a majority of the states use the federally-run marketplace at Healthcare.gov instead of having their own exchange. Initially, when the state exchanges were operational, several states made changes and switched between Healthcare.gov and their own websites. Last year Nevada transitioned to a state-run enrollment platform and this year that is in the fall of 2020 for enrollment in 2021 health plans, Pennsylvania will start using its own state-run platform, called Pennie. Even New Jersey is expected to move to a state-run platform, although the state has not announced its transition process and it is not clear whether they will transition this year or not.

Residents of Pennsylvania and New Jersey currently enrolled in a health plan through Healthcare.gov will need to pay close attention to any received communication regarding actions that they might need to take to maintain their coverage for 2021. All the remaining states will continue to use the same exchange platform which they used earlier.

Coverage Available

The open enrollment window that runs from November 1 through December 15 is applicable only for ACA-complaint individual health plans available both on and off-exchange. However, it is worth knowing that quite a small segment of people are enrolled in individual market coverage. In 2019, only an estimated 15.1 million people were having individual health coverage that also included people enrolled in grandfathered plans as well as short-term health plans, which do not have any open enrollment period.

Even the Medicare plans and employer-sponsored health plans have separate open enrollment windows and hence enrollment in these plans is not affected by these aspects. If individuals are having a grandmothered or grandfathered plan, then they should compare these plans with the ACA-compliant plans available for 2021, especially if they are eligible for premium subsidies or cost-sharing subsidies in the exchange.

Things to Know Before Enrollment

Individuals need to pay attention to the communications they receive from the exchange or from their carrier if they have off-exchange plans. Individuals need to understand the change in their premium for the coming year, and if they will be having any premium subsidy through the exchange. Individuals need to consider how much their after subsidy premium will change because that is the amount that they will actually pay each month.

Individuals also need to pay attention to the coverage details summarized in the renewal information which they receive from their insurer or the exchange. There is a possibility that health insurance companies can terminate a plan at year-end and map enrollees to a new plan with similar but not identical benefits. Even exchanges can do this if a carrier is leaving the exchange. Now since open enrollment ends in December in most of the states so it is essential for people to understand the plan details before mid-December and make changes that they think are necessary.

With not many enrollment assisters available as there used to be earlier, people need to make an appointment ahead of time with a broker or enrollment assisters in their area if they think that they may need help while selecting a plan or enrolling in a plan.

Rules for People Having health Insurance Coverage through their Employers

The open enrollment provisions and changes are only applicable to ACA-complaint individual health plans, so these changes and provisions don’t affect people who receive health coverage from their employers. However, people need to keep in mind that the open enrollment period of employer-sponsored plans may overlap with the individual plan’s open enrollment period. Most of the employer-sponsored health plans have their open enrollment period in the fall so that change in the coverage can become effective on January 1 of the coming year. However, this is not always the case and some employers may don’t follow the calendar year, so their open enrollment might be a different time of the year. Besides, employer-sponsored plans have shorter enrollment window, though employers communicate the key dates that apply to their plans to employees. Employers either hold personalized meetings or they send personalized information to each employee to prepare their employees for the open enrollment period. Employees should make use of this and should resolve all their queries or doubt they have regarding the plan before making any final decision.

Options when Open Enrollment is Missed

After the open enrollment period, individuals have limited opportunity to enroll in health insurance coverage for 2021 and they will be able to sign-up only if they experience a qualifying event. It is vital to note that some of the qualifying events like getting married or moving to a new place trigger a special enrollment period only if the enrollees had minimum essential coverage in place before the qualifying event. Thus, if individuals will miss the open enrollment period for 2021 coverage and they don’t experience a valid qualifying event later in the year then they won’t be able to sign up for a major medical health plan until the start of the next open enrollment period which will be in the fall of 2021 coverage.

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