Last week, a special enrollment period for health insurance was announced for states that use HealthCare.gov as their health insurance marketplace. Some states that do not use HealthCare.gov have decided to open their own marketplaces, too.
HealthCare.gov will be open for enrollment February 15, 2021 through May 15, 2021. Plans purchased during this period will likely be effective starting the month after you make a selection.
During this enrollment period, you can enroll in a Marketplace health plan or change to a different Marketplace health plan. (States opening their own enrollment periods may have different dates and possible actions.)
You can enroll or make changes three ways:
- Online through HealthCare.gov
- Over the phone with the Marketplace call center
- Through direct enrollment channels (e.g. working with a licensed insurance agent certified by the Marketplace)
Typically, you can only enroll in health insurance during the annual open enrollment period (November 1 through December 15). To enroll at any other time, you have to qualify for a Special Enrollment Period by experiencing a Qualifying Life Event.
This recently announced special enrollment period offers a valuable opportunity to ensure that you have the health coverage you need.
Tips for navigating the special enrollment period
If you missed open enrollment, here's your chance to enroll in the coverage you need. Having health insurance can bring peace of mind at any time. However, the peace of mind a health plan offers is only heightened during a pandemic.
As you evaluate health plans, pay attention to cost and coverage.
Health plan costs include the monthly premiums and out-of-pocket expenses.
First, let's talk about premiums. These expenses need to fit your monthly budget so you can maintain your coverage.
Subsidies on premiums are available with Marketplace plans. These subsidies are based on your income. When you apply for coverage through the Marketplace, you'll be able to check your eligibility for subsidies. Using these subsidies can make buying a health plan more affordable.
With the economic uncertainty and significant changes people are experiencing, anticipated income can be harder to estimate as you determine whether or not you'll qualify for a subsidy.
Norris notes how job loss and stimulus checks have posed some difficulty when estimating income:
"It's important to understand that unemployment benefits, including the extra federal benefits that were provided last year and again in the bill that was enacted in December, are counted as income when subsidy eligibility is determined."
In addition to ensuring that the monthly premium fits your regular budget, consider the plan's out-of-pocket costs.
Health plans have an annual deductible that must be met before the insurer begins taking more responsibility for costs. Health plans also have an annual out-of-pocket maximum. This maximum is usually higher than the annual deductible. If you reach your out-of-pocket maximum, the health insurer will take responsibility for covered health care services.
As you consider the deductible and out-of-pocket limits, look at the amounts for copays and percentages for coinsurance. These costs are usually paid at the time of service, so they're important to keep in mind.
Depending on your health needs, it can make sense to pay a higher premium for better cost-sharing and lower out-of-pocket costs.
Most health plans available offer coverage per Affordable Care Act requirements. Coverage includes mental health services, hospitalizations, preventive care, maternal care, newborn care, prescriptions, and more.
However, short-term and indemnity health insurance plans do not offer the same level of coverage. These plans often cover significantly fewer health services and don't cover pre-existing conditions.
As you navigate this enrollment period, make sure you're looking at health plans offering full coverage.
"It's also important to avoid scammy websites and sales entities that might try to piggyback on this special enrollment period in order to sell short-term plans, fixed indemnity plans, etc.
People should start at HealthCare.gov, on the "get coverage" page. When they select their state, it will either keep them on HealthCare.gov or direct them to their state's marketplace, whichever is applicable. That way they'll know for sure that they're shopping in the official marketplace for their state," recommends Norris.
As you consider health plans, understand the coverage offered and pay attention to costs to help you find a plan that meets your needs.
Implications of the special enrollment period
The special enrollment period will affect health insurers and uninsured or underinsured Americans.
Health insurance industry
Lesa Votovich, GBA Health and Benefits Vice President for Cowden Associates, Inc. observes that health insurers have responded positively to the special enrollment period:
"I would say it is welcomed mostly due to the fact that leaving individuals uncovered in general is not good for our society as a whole. It is important for individuals to have access to coverage and to obtain the care that they need. The delay in care often leads to more adverse, higher cost medical events for individuals."
Better health insurance coverage within a population can result in better health outcomes, reduce the necessity for expensive care, and protect people financially.
During this special enrollment period, many Americans will be able to enroll in a health plan, which also helps insurers manage risk.
"From a business perspective in insurance the law of large numbers applies, i.e., the more people you have insured, the more revenue you have to offset the expense and to level premiums against thus keeping insurance premiums in check," continues Votovich.
In other words, more people enrolling in health insurance helps to keep premium rates reasonable. Of course, the number of people insured isn't the only thing that affects premium rates, but it does play a role.
How much this special enrollment period will affect health insurers depends on how people respond:
"Overall, I think the true impact on the health insurance industry will be determined based on how the numbers increase and the actual level of risk that exists within those that do enroll," says Votovich.
Uninsured and underinsured Americans
According to Kaiser Family Foundation research, having health insurance plays a key role in health care access in the United States. This special enrollment period can help many Americans overcome a major health care access barrier by getting needed coverage.
Yet, simply having health insurance may not always translate to health care access for everyone.
While acknowledging the importance of having health insurance, Nicole Rochester, MD and founder of Your GPS Doc, LLC also underscores how problems with the health care system affect health care access:
"There are many structural barriers that prevent marginalized communities (even those with insurance) from accessing appropriate health care and those barriers will also need to be addressed. Getting health insurance is a first and necessary step, and I’m hopeful that we will see additional improvements moving forward."
Taking advantage of this special enrollment period? Here are helpful resources to help you assess health plans and health insurance carriers: