Affordable health insurance: your buying guide

The Affordable Care Act’s annual open enrollment period started November 1 and ends December 15 in most states. Here’s what you need to know when you’re shopping for the best health insurance to meet your needs.

What is open enrollment?

Open enrollment for 2020 ACA-compliant coverage has started and will continue through December 15 in most states (though some states have extended open enrollment). What does that mean to you?

Open enrollment is your opportunity to shop for an ACA-compliant health insurance plan that will provide coverage during 2020. If you don’t buy coverage during this annual window, your options for buying coverage will be limited until the next open enrollment period, which will start in late 2020.

ACA open enrollment basics

Consumers who take advantage of this open enrollment period (OEP) are in the individual health insurance market. If you have employer-sponsored health insurance – 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.)

Health insurance shopping options

People eligible to enroll during the OEP 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 health insurance policies, 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.)

Is open enrollment an opportunity to buy ‘cheap health insurance’?

Open enrollment is definitely an opportunity to shop for affordable comprehensive individual health insurance. 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.)

How much will health insurance cost?

The cost of your plan will depend on a number of factors, including some that are specific to you (your household income, zip code, tobacco use, and the number of people who will be covered under your plan) as well as things like plan availability in your area, and your state’s efforts to help control the cost of coverage.

[Note that when states take action to reduce premiums, people who receive premium subsidies might find that their after-subsidy premiums actually increase, sometimes significantly, highlighting the individual nature of health insurance premiums under the ACA.]

Under the ACA, the cost of individual market coverage varies significantly from one person to another, and the amount you pay might be very different from what your friend or neighbor pays. But unlike the pre-ACA days, your medical history does not play a role in determining your eligibility for coverage or your premiums, as medical underwriting is no longer used in the individual major medical market.

What is health insurance?

Health insurance – also referred to as medical insurance or healthcare insurance – refers to insurance that covers a portion of the cost of a plan holder’s medical expenses. How much the insurance covers depends on the type of coverage and specifics of the policy.

Types of insurance include individual health insurance, employer-sponsored group health 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 insurance – which includes 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 – but also include grandmothered and grandfathered plans. 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.

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

What’s the best health insurance policy?

There is no “best health insurance policy.” There’s really only a health plan that best fits your specific situation. For some people, that might mean the plan with the lowest premium, but there’s a lot more to it than that. To choose the best plan, you’ll also want to look at other factors – including provider networks, out-of-pocket costs, and the new star ratings.

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 during the open enrollment period 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 own 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 insurance.

Texas judge’s ruling does not change anything about 2019 coverage

On December 14, 2018, a federal district court judge in Texas ruled that the entire ACA is unconstitutional. This was not unexpected, and his ruling had been anticipated for several weeks.

The plaintiffs in the lawsuit (18 Republican attorneys general and two Republican governors) argued that because the ACA’s individual mandate penalty no longer exists after the end of 2018, the rest of the ACA is no longer constitutional. This is certainly a stretch, from a legal perspective, but the judge agreed with the plaintiffs.

The case was appealed, although the Department of Justice declined to defend the ACA and that task has fallen to Democratic-led states instead. Oral arguments in the appeal were heard by the Fifth Circuit Court of Appeals in the summer of 2019, and a ruling is anticipated by the end of the year.

Regardless of the ruling from the appeals court, nothing will change about the current open enrollment period for 2020 health plans. If the lower court’s decision to invalidate the ACA is upheld by the appellate court, the case is likely to eventually make its way to the Supreme Court.

A guide to individual and family health insurance

For decades, we have recognized that the individual health insurance market continues to be a source of confusion for many consumers. And since 1994, this web site has been a guide for consumers seeking straightforward explanations about the workings of individual health insurance – also known as medical insurance.

Within this site, you’ll find hundreds of articles loaded with straightforward explanations about health insurance – and the health law – all written by a team of respected health insurance experts.

Our most popular resources include:

• a guide to Obamacare’s open enrollment
• a guide to ACA’s special enrollment periods
• (and a guide to the qualifying events that trigger SEPs)
• our Obamacare premium subsidy calculator
• frequently asked questions about insurance
• a health insurance glossary
• state-by-guides to the health insurance marketplaces
• an explanation of short-term health coverage options

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Louise Norris is an individual health insurance broker who has been writing about health 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.