Open enrollment topics on this page
- When is open enrollment for 2021 coverage?
- Can I get a subsidy to help cover the cost of my health plan?
- 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?
When is open enrollment for 2021 coverage?
Although open enrollment for 2021 coverage has ended, uninsured Americans have another opportunity to sign up for 2021 coverage. And in many states, even people who already have coverage are allowed to switch to a different plan in early 2021, without needing a qualifying event.
To address the ongoing COVID pandemic, the Biden administration announced a special enrollment period that runs from February 15, 2021, through May 15, 2021. This enrollment window can be used by people who are uninsured or under-insured, as well as those who already have marketplace coverage and would prefer a different plan. It’s available in every state that uses HealthCare.gov, which includes 36 states as of 2021.
And all of the 15 fully state-run exchanges have also announced COVID-related special enrollment periods, most of which align fairly closely with the special enrollment period available on HealthCare.gov:
COVID-related special enrollment periods for state-run exchanges:
- California: February 1 to May 15
- Colorado: February 8 to May 15
- Connecticut: February 15 to March 15
- DC: Through the end of the pandemic emergency period
- Idaho: March 1 to March 31
- Maryland: Through May 15 (with retroactive effective dates available, depending on when a person enrolls)
- Massachusetts: Through May 23
- Minnesota: February 16 to May 17
- Nevada: February 15 to May 15
- New Jersey: Through May 15
- New York: Through May 15
- Pennsylvania: February 15 to May 15
- Rhode Island: Through May 15
- Vermont: February 16 to May 14
- Washington: February 15 to May 15
Some of these enrollment windows are available to anyone eligible to use the marketplace, including people who already have a plan and would like to pick a different one (that’s the approach that HealthCare.gov is using). Others only apply to people who are currently uninsured.
Read our extensive list of frequently asked questions about enrollment.
Can I get a subsidy to help cover the cost of my health plan?
Premium subsidies (premium tax credits) are available in every state to make individual market (ie, self-purchased) health insurance affordable. Eligibility is based on the applicant’s household income. Here’s a detailed overview of how premium subsidies work, and a calculator you can use to see if you’re eligible for a subsidy.
For 2021 health coverage, subsidy eligibility in the continental US extends to an income of $51,040 for a single person, and $104,800 for a family of four (the limits are higher in Alaska and Hawaii, as their poverty levels are higher, and California offers additional state-based subsidies for people with income too high for the ACA’s federal subsidies). Here’s how household income is calculated under ACA rules. It’s referred to as MAGI, for modified adjusted gross income, but it’s not the same as the general MAGI calculations you may be familiar with in other circumstances. If your income is a little too high to qualify for subsidies, there are steps you may be able to take to get it into the subsidy-eligible range.
As of 2020, there were more than 9.2 million people receiving premium subsidies in the exchanges nationwide, and their average subsidy amount was nearly $500 per month. If you haven’t checked to see if you could get financial assistance with your health insurance, make sure you do so during the open enrollment period for 2021 health coverage.
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 took effect on January 1, 2021, if you signed up during the open enrollment window in the fall of 2020. If you were already enrolled in an individual-market plan and you picked a different plan during open enrollment, your previous plan ended on December 31 and your new plan took effect seamlessly on January 1 (assuming you continue to pay all of your premiums when they’re due).
But if you’re in one of the states where open enrollment extends into January and you enrolled after mid-December, you may find that you’re enrolled in a plan with a February — or even March — start date. In that case, your previous plan would likely auto-renew for January, and the new plan will take its place when it takes effect (keep in mind that if you use the first plan in the early part of the year and then a new plan takes effect in February or March, you’ll be starting over with a new deductible and out-of-pocket limit).
If you’re enrolling via the COVID-related special enrollment periods that are available or will soon be available in much of the country, your coverage effective date will depend on where you live. If you’re in a state that uses HealthCare.gov, your coverage will start on the first of the month following your enrollment. If you’re in a state that runs its own exchange, the rules vary by state: Some will give first-of-the-followin-month effective dates regardless of when you apply, whereas others have earlier deadlines (the 15th of the month, or even the 28th of the month) in order to have coverage start the next month).
If you’re currently uninsured and waiting for a plan to take effect in February, March, or even later (in one of the states with extended open enrollment periods, or via the COVID-related special enrollment periods), a short-term medical plan can bridge the gap for you, as long as you’re fairly healthy. 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’ve enrolled in an ACA-compliant plan and are waiting for it to take effect, a short-term plan can provide peace of mind just in case you end up with an unexpected emergency before your new coverage takes effect. (You can click on your state on this map to see how short-term plans are regulated and which options are available to you). But note that short-term plans should not be thought of as a viable replacement for regular individual major medical coverage. So you’ll definitely want to sign up for an ACA-compliant plan during open enrollment, to make sure that you have solid health insurance coverage in effect during 2021.
If you enrolled during the open enrollment period but you also had a qualifying event, you may have been able to get coverage before the start of 2021. For example, if you got married and applied for coverage in November, you could have a December 1 start date if you used your special enrollment period, whereas you would have had a January 1 effective date if you just enrolled 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 earlier effective date. 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 (for 2021, rates decreased for some plans and increased for others; the specifics depend on the plan you select).
What happens if I don't enroll in a plan during open enrollment?
If you didn’t enroll in an ACA-compliant health insurance plan by the end of open enrollment (December 15 in most states), your buying options would normally be very limited until the next open enrollment starts in the fall. But due to the COVID-related special enrollment period described above, most people will have another opportunity to sign up for health coverage for 2021.
Depending on the circumstances, there are various options for obtaining coverage, even though open enrollment has ended:
COVID-related special enrollment period in most states
Due to the COVID pandemic, a special enrollment period is being offered in many states in 2021. The deadlines vary by state, but the most common is May 15, giving most people three months during which to sign up for health coverage. In most states, this enrollment opportunity applies to anyone who is eligible to use the marketplace, including people who are already enrolled and wish to change to a different plan. But in some states, the COVID-related special enrollment period only applies if you’re currently uninsured.
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
Can I preview health plans and prices?
Yes! In every state, you can browse the available plans anonymously before you create an exchange account. If you want to see rates and plan options, the information is available – online, in-person, and by phone. Here are some tips for finding it:
- Get a quote here at healthinsurance.org. You’ll want to select the option for “Affordable Care Act plans” when you’re using the shopping tool. But as noted above, if you’re also in need of a short-term plan to cover you until the end of December, you can also get quotes for those plans if you select the option for “short-term plans and alternatives” (keeping in mind that these should be thought of as a bridge plan until your ACA-compliant plan takes effect, rather than a replacement).
- ‘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). 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. You can enter an estimate of how much you expect to earn in 2021, and the shopping tools will show you the amount of premium subsidy (premium tax credit) you’ll be eligible to receive (here’s how household income is calculated under the ACA).
- Consult with a trained advisor. Set up an appointment with a navigator or broker in your area who will be able to help you sort through the available options and figure out which one will best meet your needs. (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 need to claim their new accounts at their state-run exchanges (Pennie and GetCoveredNJ), as those states have transitioned away from HealthCare.gov and enrollee data has been 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. (Note that the COVID-related special enrollment period, described above, is available to people in most states whose plans were auto-renewed for 2021. This window will allow you to pick a different plan if you wish to do so).
- 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. We know that in the 36 states that use HealthCare.gov, average benchmark premiums are about 2 percent lower for 2021 than they were for 2020. 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. This is explained in more detail in this FAQ.
- 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 (insurers are expanding their coverage areas and joining the exchanges in numerous states 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).
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.
If you’re curious about off-exchange health plans, this FAQ offers a more in-depth look at how they’re regulated and the reasons some people choose off-exchange plans.
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.
This page offers a detailed overview of how grandmothered/transitional health plans are regulated and the specific rules that apply in each state.
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.)
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.