Open enrollment topics on this page
- When does open enrollment begin?
- What information will I need in order to enroll in a health plan for 2021?
- When will my health insurance plan take effect?
- What happens if I don’t enroll in a plan during open enrollment?
- Is there a penalty for not having health insurance?
- Can I preview health plans and prices?
- Should I let my existing plan auto-renew for 2021?
- Who can help me enroll in a health plan for 2021?
- What are off-exchange health plans?
- Should I keep my grandmothered (transitional) health plan?
Open enrollment for 2021 individual-market health plans is just around the corner. Whether you’re new to the individual market or have been buying your own health insurance for years, you likely have questions.
Our guide is designed to answer those questions and give you a solid understanding of what you need to know about open enrollment and the process of obtaining health coverage for the coming year. Click on any of the links above to quickly navigate to the topic most important to you.
When does open enrollment begin?
In every state, open enrollment for ACA-compliant 2021 health coverage for individuals and families will start on November 1, 2020. In most states, it will end on December 15, 2020. The December 15 deadline applies in every state that uses HealthCare.gov (that’s 36 states in the fall of 2020) and it will also likely apply in some of the states that run their own exchanges.
But the 15 fully state-run exchanges have the option to extend their open enrollment windows, and most of them usually do so. (As of 2020, there are 13 fully state-run exchanges, but Pennsylvania and New Jersey will join them in the fall of 2020, bringing the total to 15).
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.
- Washington: November 1, 2020, to January 15, 2021.
- Massachusetts: November 1, 2020 to January 23, 2021.
- Rhode Island: 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.
Read our extensive list of frequently asked questions about enrollment.
What information will I need in order to enroll in a health insurance plan for 2021?
You can enroll for a health insurance plan online, over the phone, or in-person. Regardless of the method, if you’re enrolling in a plan through the exchange, you’re going to need to have the following information on hand for each enrollee:
- Name, address, email address, social security number, birthday, and citizenship status. (Proof of lawful residency status may be required).
- Household size and income (if you’re planning to apply for premium subsidies or cost-sharing reductions). A wide range of documentation can be used to prove your income, including pay stubs, W2s, your most recent tax return, etc.
- Coverage details and premium for any employer-sponsored plan that’s available to your household (regardless of whether you’re enrolled in that plan or have declined it).
- Payment information that the insurer will be able to use to charge your premiums.
- Your doctors’ names and zip codes, so that you can check to make sure they’re in-network with the health plans you’re considering.
- A list of medications taken by anyone who will be covered under the policy. Each insurance plan has its own formulary (covered drug list), so you’ll want to check to see which one will best cover the medications you need.
- If you want to enroll in a catastrophic plan and you’re 30 or older, you’ll need hardship exemption (note that premium subsidies cannot be used with catastrophic plans, so these are generally only a good idea if you don’t qualify for a premium subsidy, but can meet the requirements for a hardship exemption).
When will my health insurance plan take effect?
In almost all cases, your coverage is going to take effect January 1, 2021 if you sign up during the open enrollment window in the fall of 2020. If you’re already enrolled in an individual-market plan and you’re picking a different plan during open enrollment, your current plan will end on December 31 and your new plan will take effect seamlessly on January 1 (assuming you continue to pay all of your premiums when they’re due).
If you’re currently uninsured, it’s important to understand that you could have to wait up to two months from the time you enroll until the time your new plan takes effect, since open enrollment starts a full two months before the start of 2021. If you’re in that situation and fairly healthy, a short-term medical plan can bridge the gap for you.
Short-term plans are available in most states, and the coverage can take effect as soon as the day after you purchase your plan. So if you’re enrolling in an ACA-compliant plan on November 1, you can also enroll in a short-term plan on the same day. Your short-term plan will cover you until the end of the year, providing peace of mind just in case you end up with an unexpected emergency before the end of the year. (You can click on your state on this map to see how short-term plans are regulated and which options are available to you).
If you’re in a state – or Washington, DC – where open enrollment extends past December 15 (California, Colorado, Pennsylvania, and Nevada – and DC) and you enroll after December 15, your coverage will take effect on February 1 or March 1, depending on when you apply. If you were already enrolled in a plan for 2020, it will renew as of January 1 (assuming it’s still available, which is usually the case), and then your new plan selection will replace it as of February or March.
If you’re enrolling during the open enrollment period but you also have a qualifying event, you may be able to get coverage before the start of 2021. For example, if you get married and apply for coverage in November, you can have a December 1 start date if you use your special enrollment period, whereas you’ll have a January 1 effective date if you just enroll under the normal open enrollment period rules.
So if your special enrollment period overlaps with open enrollment, you might want to utilize your special enrollment period in order to get an effective date before January 1. But keep in mind that the plan will then renew on January 1, which means you’ll have a nearly immediate rate change and potential benefits change for the new year (rates are decreasing for some plans and increasing for others; the specifics will depend on the plan you select).
What happens if I don't enroll in a plan during open enrollment?
If you don’t enroll in an ACA-compliant health insurance plan by the end of open enrollment (December 15 in most states), your buying options will likely be very limited for the coming year. Open enrollment won’t come around again until November 2021, with coverage effective the first of the following year.
But depending on the circumstances, you might still be able to get coverage after open enrollment ends:
Medicaid enrollment is year-round.
Medicaid and CHIP enrollment are available year-round for those who qualify. If your income drops to a Medicaid-eligible level later in the year, you’ll be able to enroll at that point. Similarly, if you’re on Medicaid and your income increases to a level that makes you ineligible for Medicaid, you’ll have an opportunity to switch to a private plan at that point, with the loss of your Medicaid plan serving as the qualifying event that triggers a special enrollment period.
Native Americans can enroll year-round
Native Americans can enroll in plans through the exchange year-round. Here’s more about special provisions in the ACA that apply to Native Americans.
Special enrollment period if you have a qualifying event
If you have a qualifying event during the year, you’ll have access to a special enrollment period (SEP). Qualifying events include marriage (assuming at least one spouse already had coverage prior to the marriage), the birth or adoption of a child, loss of other minimum essential coverage, or a permanent move to a new geographical area where the available health plans are different from what was available in your prior location (assuming you already had coverage prior to your move).
Here’s a full guide to all of the qualifying events that trigger special enrollment periods in the individual market, including details about the specific rules that apply to each of them.
Short-term health plans
Under general federal rules, short-term health insurance plans can have initial terms of up to 364 days and a total duration of up to 36 months, including renewals. But the majority of the states placed more restrictive limits on the availability of short-term plans, and those state limits supersede the new federal rules.
You can visit our short-term health insurance page to check your state’s guidelines.
Is there a penalty for not having insurance?
There is no federal government penalty for being uninsured in 2021, but you still need coverage!
The ACA’s federal individual mandate penalty has been $0 since the start of 2019, and that will continue to be the case in 2021. People who are uninsured will not face a penalty, unless they’re in a state that has its own individual mandate and a penalty for non-compliance. Four states and DC impose tax penalties for not having health insurance:
- New Jersey
- Rhode Island
- District of Columbia
Open enrollment begins on November 1. That’s the first day you can complete the enrollment process and select a plan for 2021. But there are steps you can take before November to make sure that you’ve got all your ducks in a row. If you want to see rates and plan options, the information may be available – online, in-person, and by phone. Here are some tips for finding it:
- Get a quote here at healthinsurance.org. If you do this more than a week or so in advance of open enrollment, you’re going to be getting quotes for 2020 coverage. But it will give you an idea of what’s available and you’ll be able to have someone walk you through the process of what to expect when open enrollment begins.
- ‘Window shop’ anonymously on your state exchange (if you’re in DC or one of the 14 states that run their own exchanges) or HealthCare.gov’s plan browsing page (if you’re in one of the other 36 states). If you’re window shopping far in advance of open enrollment, you’ll be seeing rates and plans for 2020. But starting in October, window shopping pages will begin to show rates and plans for 2021. This is generally available in all states by the last week in October. The window shopping tools that are available through the exchanges are anonymous and do not require you to enter any identifying information; they offer a quick and easy way to get a good idea of what’s available to you.
- Check with your state insurance department. Many of them make rates and plan information available on their websites well in advance of open enrollment. Keep in mind, however, that you won’t be seeing premium subsidies incorporated into the rate information that might be available on your state insurance department’s website. Premium subsidies make coverage much more affordable, and they’re available to a family of four earning up to $104,800 in 2021.
- Consult with a trained advisor. Set up an appointment with a navigator or broker in your area who will be able to help you once open enrollment begins. (See below for more information about the enrollment assisters who can help you.)
- Talk with your health care providers. This is helpful especially if you’re considering a policy change during open enrollment. You’ll want to know which provider networks include your doctors, and whether any network changes are planned for the coming year.
Should I let my existing health plan renew for 2021?
If you’re already enrolled in an ACA-compliant health plan through your state’s marketplace, can you just let that plan automatically renew for 2021? In most cases, yes, assuming your plan will still be available next year.
Auto-renewal is an option for nearly all exchange enrollees, although Pennsylvania and New Jersey residents will need to claim their new accounts at their state-run exchanges (Pennie and GetCoveredNJ), as those states are transitioning away from HealthCare.gov and enrollee data is being migrated to the new exchange platforms.
But relying on auto-renewal is not in your best interest. No matter how much you like your current plan, it pays to shop around during open enrollment and see if a plan change is worth your while. Here is why:
- In most states, you won’t be able to pick a new plan after your coverage is auto-renewed. The auto-renewal process happens right after December 15, for people who haven’t manually renewed or selected a new plan. In most states, that’s after the end of open enrollment, which means you won’t get a chance to change your mind if it turns out that your plan’s after-subsidy premiums are increasing or the provider network is changing.
- Your subsidy amount will generally change from one year to the next. If your subsidy gets smaller, auto-renewal could result in higher premiums next year. As has been the case for the last couple of years, there are a plethora of new insurers entering insurance markets all across the country for 2021. This is good news in terms of competition and plan options. But if those plans are priced below the existing options, they can bring down the cost of the benchmark plan and reduce premium subsidies for everyone in the area. Shopping around for a different plan — as opposed to letting your plan auto-renew – might result in substantial savings.
- If you receive a subsidy, auto-renewal could be dicey even if the subsidy amount isn’t declining. If you rely on auto-renewal (as opposed to manually renewing and completing the financial eligibility determination process for 2021), the exchange can renew your plan without a premium subsidy in certain circumstances. This includes situations in which the most recent tax return on file shows that your income was over 500% of the poverty level or below 100% of the poverty level. It also includes situations in which you didn’t give the exchange permission to access your financial information in subsequent years.
- If your plan is being discontinued, auto-renewal will result in the exchange or your insurer picking a new plan for you. They will try to assign you to the closest match to what you have now, but selecting your own new plan is a better option.
- Auto-renewal might result in a missed opportunity for a better value. Even if the plan you have in 2020 represented the best value for this year, there may be different plans available for 2021. Provider networks and benefit structures can change from one year to the next, as can premiums. You might still decide that renewing your current plan is the best option for 2021. But it’s definitely better to actively make that decision rather than letting your plan auto-renew without considering the other available options.
Who can help me enroll in a health insurance plan for 2021?
Health insurance is complicated, and many people want or need personal assistance with the application process and with ongoing insurance utilization questions. To fill this need, there are a variety of assisters nationwide who are trained to guide people through the process of researching and enrolling in health plans, and some can provide ongoing support after the plan is purchased.
Health insurance navigators
The health insurance Navigator role was created for the purpose of providing impartial education and outreach about the exchanges and exchange health plans, helping applicants determine whether they qualify for subsidies or Medicaid, and assisting them in the enrollment process. Standards and regulations for the Navigator program are outlined in 45 CFR 155.210 and CFR 45 155.215.
In early 2016, HHS laid out enhanced requirements for Navigators – most of which took effect for 2018 – including targeted assistance for underserved and uninsured populations, as well as post-enrollment assistance (on issues such as eligibility appeals and health insurance utilization). The enhanced requirements are detailed in 45 CFR 155.210(e)(9). But in the guidelines for 2020, HHS reversed course somewhat on this, making those duties optional, rather than required, for Navigator organizations. So some Navigator organizations now provide assistance with things like subsidy reconciliation and eligibility appeals. But they are no longer be required to offer these services.
Navigators are not permitted to recommend one plan over another or direct consumers towards a particular policy. Instead, their job is to provide general information that consumers can use to understand what’s available to them. Navigators are paid by state and federal grant programs, and they cannot be compensated by the insurance companies.
Certified application counselors (CACs)
Certified application counselors (CACs) can also provide assistance with the enrollment process. They are similar to Navigators, but their role is more limited and their focus tends to be strictly on helping people enroll, without the more extensive assistance that some Navigators can provide.
The exchange designates local “CAC organizations” (health centers, faith-based organizations, colleges, etc.) and people who are affiliated with or employed by those organizations are eligible to serve as CACs. Navigators are funded through the exchange, but certified application counselors are not. Funding for the CAC program can come from a variety of state and federal sources though, including existing public health appropriations. And CACs themselves are often volunteering their time to help people enroll in health coverage.
Insurance brokers and agents
Insurance brokers and agents who are certified by the exchanges can also explain plan details and help consumers determine subsidy or Medicaid eligibility, but – and this is a key difference – they can also make plan recommendations based on a client’s particular situation.
Agents and brokers continue to assist their clients after the plan is purchased, helping them sort out questions and problems regarding billing, utilization, claims, and appeals. Brokers and agents also generally carry errors and omissions insurance, and are licensed by their state department of insurance (this is in addition to their certification with the exchange; Navigators and CACs are trained and certified by the exchange, but are not licensed by the state insurance department).
An off-exchange plan is just a health insurance policy that is purchased directly from the insurance company or through an agent or broker, outside of the official ACA-created health insurance exchange. When we refer to off-exchange plans, we’re only talking about major medical coverage – the plans to which ACA regulations apply. A plethora of “excepted benefit” plans (such as short-term health insurance) are also sold outside the exchanges in most states, and are exempt from ACA regulations. But our discussion of off-exchange plans only refers to ACA-compliant plans sold outside the exchanges.
ACA consumer protections apply to all individual major medical policies, regardless of whether the coverage is sold in the exchange. And the same open enrollment window – November 1 to December 15 in most states – applies regardless of whether the plan is sold in the exchange our outside the exchange.
But the ACA’s premium subsidies and cost-sharing reductions are only available if you buy a plan in the exchange. If you purchase the exact same plan directly from the insurance company (ie, off-exchange), you’ll have to pay full price, there will be no cost-sharing reductions available, and you won’t have an option to claim the premium tax credit when you file your tax return the following year. If you think that you might be subsidy-eligible, the exchange is definitely where you want to shop.
Should I keep my transitional health plan (grandmothered) for 2021?
If your current health insurance policy is not grandfathered but was in effect prior to 2014, your plan is considered a transitional health plan or “grandmothered policy.” These plans are not fully ACA-compliant, and were purchased between March 23, 2010 – when the ACA was signed into law – and the end of 2013.
Transitional health plans can remain in force throughout 2021 if states and insurers allow it
Transitional health plans were initially slated to end in 2014. But extensions have been granted by the federal government every year, allowing these plans to remain in force if the state agrees and if the insurer still wants to renew the plans. The latest extension allows transitional health plans to renew up until October 1, 2021, and remain in force until the end of 2021. (Without another extension, transitional plans will have to be replaced with ACA-compliant plans as of 2022.)
Transitional health plans still exist in 32 states. (In the remaining states, these plans were either required to terminate or insurers voluntarily terminated them and replaced them with ACA-compliant coverage.) Most of those states are continuing to allow transitional plans to renew for 2021.
Carefully consider the new plans available to you before you decide to renew your transitional plan
If you’re enrolled in a transitional plan and your insurer is offering renewal for 2021, you have the option to keep your plan for another year. But it’s definitely in your best interest to carefully compare your plan with the new options that are available in the ACA-compliant market for 2021.
You might find that you’re eligible for premium subsidies, even if that wasn’t the case in the past. (Premium subsidies for 2021 are available for a single person with an income up to $51,040. In 2014, a single person could only qualify for subsidies with an income of up to $45,960; as the poverty level increases each year, so does the income cap for subsidy eligibility.)
And the ACA-compliant plans available now are likely to provide more robust coverage – including all of the essential health benefits – than the plan you purchased prior to 2014.
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.