November is a busy month for planning your future for health care insurance. 1) November 3rd is Election Day so please get out and vote and let your voice be heard. 2) open enrollment for health insurance November 1st and runs through December 15th. Understanding the different types of plans, acronyms can make choosing the right plan overwhelming.
In addition, choosing a health plan during an election year can be trying, especially this year where health care is a heated topic and both contending candidates have such opposing views. Also factoring in that so many people have lost their jobs and health insurance due to COVID-19. Most are unsure what options are available having always had health insurance through their employer or if purchasing an individual plan will even be affordable. Another question is what could happen if the Affordable Care Act (ACA) is repealed. What Happens To My Family If The Affordable Care Act Is Repealed?
I am updating several blog posts that will provide you with the most current information. I hope these posts will demystify purchasing a health care insurance plan so you can choose what is best for you and your family.
2021 Open Enrollment – Dates
For most states open enrollment will be November 1, 2020 – December 15, 2020. This enrollment timeline are for the states that use HealthCare.gov as their platform. I would add given that the National Public Health Emergency was expanded another 90 days making the next end date January 22, 2021 this could potentially impact open enrollments dates with a longer window to enroll. I will be sure update should these changes occur.
There are 15 states that have their own state-run exchanges and their enrollment dates may be different. They also have the option to extend their enrollment periods.
California, Colorado, and DC have permanently extended their open enrollment periods:
- California: November 1 to January 31
- Colorado: November 1 to January 15
- District of Columbia: November 1 to January 31
Other state-run exchange enrollment deadline extensions:
- Minnesota: November 1 to December 22, 2020.
- Pennsylvania: November 1, 2020, to January 15, 2021
- Nevada: November 1, 2020, to January 15, 2021.
- Massachusetts: November 1, 2020 to January 23, 2021.
- New Jersey: November 1, 2020 to January 31, 2021.
- New York: November 1, 2020 to January 31, 2021.
Source: HealthInsurance.org
Buying On-Exchange (Marketplace)
Buying on the exchange is also referred to as buying through the Marketplace. The Marketplace is an online store or platform where insurance companies feature their plans for purchase. The Marketplace is run by the federal government or state-owned.
Once you select a site to review plans, you will go through a questionnaire to determine best plans and if you qualify for cost sharing or a subsidy. The subsidies are options to reduce your out of pocket expenses. To identify what you or your family may qualify for go to: HealthCare.gov: Income and Savings. Another, benefit of the Marketplace plans, is they are required to provide essential benefits per the Accountable Care Act (ACA). To learn more about essential care benefits, refer to Health Agents, What are Essential Health Care Benefits. Essential benefits are for individual and small groups. Large groups are not required to offer these benefits.
Options to purchase health insurance in the marketplace are from Healthcare.gov or an exchange program offered by your state. If you use the Healthcare.gov link, choose your state. If your state offers an online store or platform, a link will be available, so you can go directly to your state’s site.
Buying Off Exchange
Individual and small group plans are offered directly from health insurance companies (Humana, Aetna, Cigna etc.) or through a licensed broker. Typically, these plans will include the essential health benefits and are similar, if not the same offered on the marketplace, but this is not always the case, so shop smartly, if these benefits are important to you. The most significant difference is you will not be able to receive a cost sharing, subsidy or discounts for the plans. One other point to add is not every health insurance company provides plans on the exchange, so if you have a self-insurance company you prefer, and they are not on the exchange then purchasing off the exchange will be your only option.
When should you use On Exchange versus Off Exchange?
On Exchange
- You’re not sure but believe you may qualify for a subsidy.
- You would like to see what options are available if you need assistance in paying for health care.
- You know you don’t qualify for Medicaid but paying for a plan will be tight on the budget, and you need to be budget conscious when choosing a plan.
Off Exchange
- You know you don’t qualify for Medicaid.
- You have no concerns in paying for your monthly premium.
- You have been seeing a health care provider you want to continue to see and know this health care provider does not accept plans on the exchange.
Other Key Points
Plans purchased will be available January 1, 2021.
- Example: You are with United Health Group and you purchase a new plan with Humana for 2021. Your plan will with United Health Group will remain in effect until December 31, 2020. Your new plan with Humana will go into effect January 1, 2021. Make sure if you are choosing a new plan that you let your health care provider know of the change and provide them with your new insurance card, to avoid issues with authorizations for services and payment for care.
If you are currently uninsured and purchase a plan on November 1st, you will have close to a 2-month gap until your new plan kicks in. If this is a concern to you there are options. Short term plans may be purchased for this gap in time to provide peace of mind or if you have an immediate health concern that needs to be addressed prior to the January 1, 2021 effective date of the plan you purchased.
You may opt to not purchase health care insurance in 2021. While the federal individual mandate no longer applies in terms of penalty, there are some states that are implementing their own mandates. You will no longer be charged a penalty if this is the choice you believe is right for you. However, this will continue to change, but for now refer to Health Insurance.org to view the current state mandates. Refer to eHealth: Does Your State Require You to Have Health Insurance?
In the next entry, I will focus on the difference plan types: DHMO, HMO versus PPO, POS to provide additional information that I hope is helpful when making the right choice for you and or your family for 2021 Health Care Enrollment.
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Resources:
Broken, Bankrupt, and Dying: How to Solve the Great American Healthcare Rip-off
Medicare For The Lazy Man 2020: Simplest & Easiest Guide Ever!
The Price We Pay: What Broke American Health Care–and How to Fix It