Open Enrollment 2021: A Pandemic and a Supreme Court Hearing

2020 has affected our daily lives in profound ways. Job loss affected access to health insurance and health care in the middle of a pandemic. 

Health insurance changes may also be on the horizon because the Supreme Court starts hearing a case on the Affordable Care Act in November. A decision is anticipated in 2021.

COVID-19 and potential changes to health insurance laws make this year's Open Enrollment period more important than ever.

Employers are also feeling pressure from COVID-19's fallout, which may affect the health insurance options they offer employees.

Whether you're buying health insurance on your own or through your employer, shopping for and enrolling in health insurance for 2021 has more significance than past years.

A recent study from Unum found that 64 percent of workers plan to pay more attention and spend more time reviewing their benefits and 36 percent plan to enroll in different benefits.

While there is no data on these questions to compare with previous years, these numbers do show that workers are making adjustments and planning to increase time understanding their workplace benefits.

As we enter the Open Enrollment period, here's what you should know as you select health insurance plans. 

COVID-19 pandemic

We're all too familiar with stories of COVID-19 patients needing care in the ICU, and that level of medical care can add up quickly.

The U.S. legislative responses to COVID-19 provided resources to cover COVID-19 care for uninsured individuals. 

Although those resources make a difference, buying health insurance can offer valuable financial protection, peace of mind, and help you access medical care when you need it.

Fortunately, there's good news if you're buying your own insurance. 

"Because the marketplaces are strong and healthy, we’ve seen an increase in the number of insurers participating and an increase in the number of options being offered. Regardless of the pandemic, high-quality, affordable and comprehensive coverage remains available," says Joshua Peck, cofounder of Get America Covered.

The risks of going without health insurance are starker this year than they were last year. Insurance premiums aren't cheap, but it's worth making adjustments to your budget and exploring subsidies available to fit it in.

Peck continues, "It’s always risky to be without coverage. No one knows when they’ll have an emergency or develop a serious health problem. Last Open Enrollment, no one deciding whether to get covered or not could’ve anticipated this pandemic. It’s abundantly clear that this pandemic is not temporary. It’s not going away any time soon, and no one understands the long-term health implications of even mild cases of COVID-19. Everyone deserves to enjoy the peace of mind offered by health coverage — especially amidst this potentially devastating illness."

If you receive insurance through an employer group plan, you may see some changes. These will vary by employer, so it's difficult to make generalizations at this point.

Peter Nieves, Chief Commercial Officer and benefits management expert with WINFertility, provides wise insight for employees who want to maximize their benefits:

"Employers may shift costs to employees through higher deductibles and coinsurance or only offer a high deductible plan. Employees should consider optimal use of FSA, HSA or HRA accounts and, if not enrolled in an HDHP, consider the lower monthly cost of the offer. If an Employee will have a greater cost share burden in 2021 for care, then be sure to not delay treatment, surgery or testing and take thoughtful action in 2020."

Although changes are possible, Lesa Votovich, Vice President of Health and Benefits at Cowden Associates, Inc., notes that employers are working to avoid making changes:

"In the group marketplace, it has been my experience thus far that employers are trying to make as few changes as necessary, recognizing the impact that the pandemic has had on their employees this year. They definitely are not looking to add more insult to injury wherever possible."

Supreme Court case

The Supreme Court will start hearing arguments for California vs. Texas in November. This case calls the Affordable Care Act's (ACA) "individual mandate," requiring everyone to purchase health insurance, into question. 

The Court's ruling could upend the health insurance landscape we've become accustomed to if the ACA is overturned.

The ACA protected people with pre-existing conditions from being denied coverage or charged higher premiums on policies. It allowed children to stay on their parents' health plan until age 26. It expanded Medicaid and instituted income-based subsidies on Marketplace monthly premiums that made buying a good health insurance plan more affordable.

Insurers used to have annual and lifetime benefit maximums that shifted excess costs on policyholders and limited the benefits available to people with chronic conditions.

"It’s difficult to predict how the Supreme Court will rule and thus hard to predict how it will impact people enrolled in health plans. But no decision is likely until June of 2021, so anyone who needs coverage now should check out their options, enroll, and know that their coverage is secure," advises Peck.

Although there is uncertainty, it's important to consider the potential fallout if the ACA is overturned by the Supreme Court.

Votovich paints a bleak picture of the effects that ruling could have: "Should the Supreme Court decide to strike down the ACA, more than 20 million people will lose their health care coverage. These are individuals who obtain their health care policy through a federal marketplace plan. Those covered by employer-sponsored health care coverage will likely still remain covered by that plan. Currently, as we are in the midst of the pandemic, continued racial disparities in coverage and the heightened likelihood of a potential financial crisis, the impact of individuals losing coverage would be devastating."

Anticipate how the Supreme Court ruling to uphold or overturn the ACA would affect you. Make sure you get the coverage you need for 2021 during Open Enrollment.

Votovich shares this advice:

"Understand the coverage that you are purchasing. If you are uncertain and have questions about the options available to you, seek out an agent who can assist you in navigating the plans. Assess the typical services that you receive in a year and disclose them to the agent you may work with so that they can provide you with options that may best meet your needs.  

Most importantly, don’t let your coverage lapse. If the Supreme Court does strike down the ACA, you want to make sure that you have continuous health coverage so that you may avoid being limited by pre-existing condition policy limitations in the future. If history holds true, if one does have coverage for a continuous period without a 60-day lapse, then pre-existing conditions will not likely apply."

We have time before the Supreme Court issues a ruling. If the Court overturns the ACA, some of the changes will be immediate. Others will take more time.

"Once the ruling is made there will likely be a noted transition period. For example, if the Court rules next June there may be a period of six months to a year for insurers to decide how they will react to the ruling and formulate what their individual market will look like on a go forward basis," says Votovich.

Managing through uncertainty

One of the challenges of 2020 has been confronting uncertainty and dealing with the unexpected. We've confronted realities in new ways and adapted to new circumstances. 

Enrolling in a health plan during Open Enrollment can help you be prepared for uncertainty in 2021, whether it's unexpected medical expenses or transitioning to an unfamiliar health insurance landscape.

Use the checklist below to help you navigate this year's Open Enrollment period.