Affordable health insurance: your buying guide

When does 2021 open enrollment start?

Open enrollment for 2021 ACA-compliant coverage is just around the corner. (It starts November 1 and runs through December 15 in most states).

Read our guide to 2021 open enrollment.

Open enrollment is a window during which individuals may add or drop their health insurance, or make changes to their coverage.

Until then, Americans can purchase ACA-compliant coverage if they have a special enrollment period. Those opportunities for special enrollment have been in flux in response to the coronavirus pandemic as many states added coronavirus-related special enrollment periods.

The November 1 – December 15 enrollment window is for people who buy their coverage in the individual market. If you have employer-sponsored coverage – or if you’re covered by Medicare, Medicaid, Tricare or the Indian Health Service – different enrollment windows apply for your coverage.

Medicare’s enrollment window is similar, but it ends on December 7. And your employer’s enrollment window may very well happen during this time of year, but it will have its own dates. (If you’re eligible for Medicaid or CHIP, you can enroll at any time during the year.)

ACA plan shopping options

People eligible to enroll during the OEP or a special enrollment period have several options for buying ACA-compliant coverage:

• Through a marketplace – your state’s exchange or HealthCare.gov. These exchanges vary by state, but were designed to make it easy for people to compare plans, determine eligibility for subsidies, and enroll in ACA-compliant coverage. Find out what type of exchange your state uses.
• From agents and brokers who are certified by the exchanges to help explain ACA-compliant coverage options, determine your eligibility for subsidies, and make plan recommendations based on your situation. Learn more about brokers and agents.
• Through online portals – including healthinsurance.org – where you can find a quick health insurance quote or get help enrolling in an ACA-compliant plan from a licensed, exchange certified broker. (Call 1-844-608-2739 to talk to a certified broker.)

Most special enrollment periods apply both on-exchange and off-exchange, although it essential for anyone who is eligible for premium tax credits to enroll through the exchange if and when they have a special enrollment period.

Depending on your household income, you may be eligible for premium tax credits (aka, premium subsidies) and possibly cost-sharing reductions (CSR, aka, cost-sharing subsidies). Don’t sign up for an off-exchange plan and miss out on the possibility of much more affordable premiums via a tax credit.

Without a qualifying event, ACA-compliant coverage is generally not available outside of open enrollment. (There are some exceptions: Native Americans can enroll year-round, and so can anyone eligible for Medicaid or CHIP.)

Is open enrollment or a special enrollment window an opportunity to buy ‘cheap health insurance’?

Open enrollment or a special enrollment period is definitely an opportunity to shop for affordable comprehensive individual health coverage. Thanks to premium and cost-sharing subsidies established by the Affordable Care Act (aka Obamacare), buying an affordable major medical plan is a realistic option for millions of Americans who are eligible.

Premium subsidies – which are actually premium tax credits – can lower the costs of any metal-level ACA-compliant plan bought through the exchange in your state (this includes plans purchased via “enhanced direct enrollment” entities that work with the exchange, as well as brokers and agents who help clients enroll in plans through the exchange). Here’s how to find out whether you’ll be eligible for a subsidy.

Use our calculator to see the estimated size of your premium subsidy.

If you think it’s likely you’ll be eligible for a subsidy, be sure to familiarize yourself with the basics of ACA subsidies. You’ll want to make sure that you get the maximum subsidy but also that you understand your options for claiming your subsidy. (Your choice in how to receive a subsidy could determine whether you’ll end up repaying some or all of your subsidy.)

Health coverage is sort of like airline tickets: Chances are, you’re not paying the same amount as your neighbor. Roughly half of Americans get their health insurance from an employer — with varying premiums — and more than a third get coverage from Medicare — also with varying premiums — or Medicaid.

There are also about 15 million people who buy their own health insurance in the individual market. For these folks, premiums vary considerably based on where they live, how old they are, and how much they earn. In most states, premiums can also vary based on tobacco use.

So what are people actually paying for individual plans that they buy for themselves? As of mid-2019, there were about 10.2 million people with effectuated coverage through the exchanges. Their average per-person premium was about $593 per month, but that was before any income-based premium subsidies were applied: Eighty-seven percent of those enrollees were receiving premium subsidies, which reduced their monthly premiums by about $514.

There’s a lot of variation from one state to another — average premiums were $947 per month in Wyoming, and $391 per month in Massachusetts. But in every state, premium subsidies cover the majority of the premiums for the majority of enrollees. And millions of people, including more than 4 million who were uninsured as of 2019, can get coverage with no premium at all, because the available subsidies are enough to cover the entire premium.

People who don’t get subsidies pay full price, and this includes anyone who buys their coverage outside the exchange. But some of these people may have employers who cover some or all of the cost via a health reimbursement arrangement.

For people who simply can’t afford an ACA-compliant plan, short-term health plans are an option in most states. These policies can have premiums under $50 per month for younger people. And although the rates are higher for older people, a 50-something applicant will generally see numerous short-term plans with premiums under $250 per month.

Types of insurance include individual health insurance, employer-sponsored group insurance, Medicare, Medicaid, CHIP, Tricare and insurance for government employees (FEHB). If you’re reading this, it’s likely because you’re seeking information about individual health plans – which include Obamacare (ACA-compliant) plans.

Those plans are major medical insurance that was mandated by the law to include essential health benefits and offer coverage on a guaranteed-issue basis. Types of ACA plans include preferred provider organization (PPO) plans and health maintenance organization (HMO) plans, but also point-of-service (POS) plans and exclusive provider organization (EPO) plans.

Some people with individual market coverage still have grandmothered and grandfathered plans, although those plans are no longer available to new enrollees.

Coverage costs for the plan holder include premiums, deductibles, copayment and coinsurance.

You can learn more about how to shop for a plan that’s perfect for you in our Insider’s Guide to Obamacare’s Open Enrollment.

Here’s an at-a-glance overview of some things to be aware of for 2020 health plans — including lots of states where new insurers have joined the exchange, updated subsidy-eligibility guidelines (and new subsidies in California), new individual mandates in California and Rhode Island, a new state-run enrollment platform in Nevada, and lots more. You’ll find more details in our Insider’s Guide to Obamacare’s 2020 Open Enrollment.

Alternatives to ACA-compliant coverage

Because ACA-compliant plans offer a long list of coverage protections – and the potential for subsidies to reduce premiums and out-of-pocket costs – we encourage our readers to explore ACA-compliant coverage options first. At the same time, we do recognize that there is a segment of the individual market population that can’t or won’t purchase ACA-compliant coverage:

• Millions of Americans are caught in the coverage gap in states that haven’t adopted the ACA’s Medicaid expansion.
• Millions of other Americans are stranded by the family glitch, which makes them ineligible for subsidies.
• Other Americans with incomes above 400 percent of the poverty level – and thus ineligible for the ACA’s subsidies – simply can’t afford the coverage costs of ACA-compliant plans. [It’s essential to understand how “income” is calculated under the ACA, and to know that pre-tax retirement plan contributions and HSA contributions will reduce your income and potentially make you eligible for a subsidy, even if you start with an income above 400 percent of the poverty level.]

The good news: there’s a wide range of short-term health coverage available in most states that could provide a temporary safety net until these consumers get access to more comprehensive coverage.

2018 rule makes longer short-term coverage easier to buy

Consumers who are unable to afford ACA-compliant coverage can now purchase short-term coverage with a much longer duration in many states. Federal regulation changes in late 2018 made it possible for many buyers to purchase a short-term plan with an initial duration of nearly a year – with renewal options that allow the plan to remain in force for up to three years.

• Does your state regulate short-term coverage? Read about plan and carrier availability.
• Read more FAQs about short-term health plans.

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Louise Norris is an individual health insurance broker who has been writing about insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.