2020 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

AND WE'RE OFF! Seven important things to remember for 2020 #ACA Open Enrollment

Starting today, November 1st, the Seventh Annual ACA Open Enrollment Period is upon us! As I do every year, here's a list of important things to remember when selecting a health insurance policy. Some of these are the same every year and apply nationwide; others are specific to the 2020 enrollment period and/or to particular states.

1. DON'T MISS THE DEADLINE!

California actually launched Open Enrollment for 2020 on October 15th, but for the other 49 states (+DC) it starts on November 1st. The deadline for Open Enrollment is December 15th in most states for coverage starting January 1st, 2020, but eight states which operate their own ACA exchanges have extended deadlines:

  • California: January 31st, 2020
    • enroll by 12/15 for coverage starting January 1st
    • enroll between 12/16 - 1/15 for coverage starting February 1st
    • enroll betweeen 1/16 - 1/31 for coverage starting March 1st
  • Colorado: January 15, 2020
    • enrll by 12/15 for coverage starting January 1st
    • enroll between 12/16 - 1/15 for coverage starting February 1st
  • District of Columbia: January 31, 2020
    • enroll by 12/15 for coverage starting January 1st
    • enroll between 12/16 - 1/15 for coverage starting February 1st
    • enroll betweeen 1/16 - 1/31 for coverage starting March 1st
  • Idaho: December 16th, 2019
    • (they're bumping the deadline out by one day since the 15th falls on a Sunday this year)
  • Minnesota: December 23, 2019
  • Massachusetts: January 23, 2020
    • enroll by 12/23 for coverage starting January 1st
    • enroll between 12/24 - 1/23 for coverage starting February 1st
  • New York: January 31, 2020
    • enroll by 12/15 for coverage starting January 1st
    • enroll between 12/16 - 1/15 for coverage starting February 1st
    • enroll betweeen 1/16 - 1/31 for coverage starting March 1st
  • Rhode Island: December 31st, 2019

Some of the exchanges will either allow you a few days grace period to finish up your enrollment process as long as you start it by midnight on the deadline date, but if you miss the deadline, you won't be eligible to enroll for ACA-compliant major medical coverage for the rest of the year unless you qualify for a Special Enrollment Period (SEP) due to a qualify life event lke getting married/divorced, moving, giving birth/adopting a child, turning 26, becoming ineligible for Medicaid or losing your employer-sponsored health insurance coverage.

2. MAKE SURE YOU'RE ENROLLING IN ACA-COMPLIANT COVERAGE!

There's a ton of junk plans and scam artists out there, especially these days. Fraudulent plans are being hawked endlessly via both robocalls, spam emails and fly-by-night websites. If you're enrolling online, make sure to use one of the official ACA exchange websites:

  • There are also authorized 3rd-party web brokers you can use...but some of these also sell non-ACA compliant plans. The only 3rd-party broker which I'm aware of which only sells on-exchange ACA-compliant policies is HealthSherpa. Full disclosure: I have a banner ad agreement with them.

Note: You can enroll in ACA-compliant policies directly via the insurace carrier's website as well, but the only way to be eligible for ACA tax credits is if you enroll on-exchange. That's the other reason I strongly recommend using one of the above websites.

NEVADA RESIDENTS: Don't forget that NV split off onto their own ACA exchange website for 2020 at NevadaHealthLink.com.

3. THE INDIVIDUAL MANDATE MAY BE GONE FOR MOST STATES, BUT IT'S STILL AROUND IN FIVE OF THEM!

Two years ago, Congress infamously "zeroed out" the federal ACA Individual Mandate Penalty, which imposes an extra tax for anyone who doesn't have ACA-compliant healthcare coverage for the year (or qualifies for an exemption from the penatly). This has led to any number of consequences including a lawsuit which could potentially result in the entire ACA being struck down in the future...but for the most part, it means that residents of most states will not face a tax penalty for not having adequate healthcare coverage.

There are, however, five states which have reinstituted their own healthcare coverage requirement (technically it's six, but Vermont's doesn't count as they have no specific enforcement mechanism yet):

  • CALIFORNIA
  • DISTRICT OF COLUMBIA (I know, it's not actually a state yet)
  • MASSACHUSETTS
  • NEW JERSEY
  • RHODE ISLAND

In CA, DC, NJ & RI, the penalty is pretty much identical to the old federal penalty: Either $695.00 per adult or $347.50 per child in the household or 2.5% of the total household income, whichever is greater. Massachusetts uses a different formula. The financial penalty will be charged when residents file their 2020 state taxes in 2021.

4. YOU MAY QUALIFY FOR TAX CREDITS IN 2020 EVEN IF YOU DIDN'T IN 2019...AND IT CAN MAKE A BIG DIFFERENCE!

  • Since the threshold for tax credits is 4x the FPL, the income cut-off for being eligible to receive tax credits is actually increasing by $1,400 for a single person or $2,600 for a family of four.
  • That means that if your household income is only a little over the 400% FPL line in 2019 and doesn't change much, you may end up qualifying in 2020 after all. For instance, if you're single and earned exactly $49,900 in 2018, you didn't qualify for credits in 2019...but if you earn the same amount in 2020, you very well may! If so, this could save you thousands of dollars on your premiums for 2020.

Therefore, it's vitally important that everyone visit HC.gov (or their state exchange website) & plug in their projected 2020 info to see whether they qualify or not.

4a. A LOT MORE CALIFORNIA RESIDENTS IN PARTICULAR MAY BE ELIGIBLE FOR SUBSIDIES THIS YEAR!

Again: The ACA's subsidy formula cuts off all financial aid to anyone earning more than 400% FPL (roughly $50,000 for a single person or $103,000 for a family of four). Starting this year, however, California is offering additional subsidies to those already elgiible...as well as expanding subsidies to ACA enrollees who earn between 400-600% FPL. Not everyone in that range will qualify, and the subsidies won't be that generous for all of those who do...but enrollees earning 400-450% should see substantial savings.

5. VIA SILVER LOADING, SOME SUBSIDIZED ENROLLEES MAY BE ABLE TO GET A GOLD PLAN AT BARGAIN PRICES OR A BRONZE PLAN FOR FREE.

  • As I explain here, most states have loaded the full Cost Sharing Reduction (CSR) cost onto Silver plans only. This means that Bronze & Gold plans will only go up the normal amount, while Silver plans will go up a lot...but the tax credits (for those eligible) also go up a lot to match the Silver increase, and those credits can be applied to any exchange plan. This means subsidized enrollees may end up getting a Gold plan for less than Silver, or a Bronze plan dirt cheap (or even free!).
  • Every state except for three (Indiana, Mississippi and West Virginia) is Silver Loading for 2020.

Therefore, SHOP AROUND, SHOP AROUND, SHOP AROUND!

6. HOWEVER, SOME ENROLLEES WHO BENEFITED FROM SILVER LOADING IN 2019 MAY SEE THE REVERSE EFFECT IN 2020.

As I explain here, the "benchmark Silver" formula works both ways: If the benchmark premium goes up, so do tax credits for subsidized enrollees...but if the benchmark premium drops, so do those same tax credits.

If the benchmark premium increases more in hard dollars than bronze or gold premiums do, you can use the higher tax credits to lower the price of the bronze/gold plan by a greater amount...but if the benchmark premium drops by more than the bronze/gold premium does, the opposite is true. Someone who went from $50/month in tax credits to $300/month might drop back down to $50...or even less.

Therefore, SHOP AROUND, SHOP AROUND, SHOP AROUND!

7. WHATEVER YOU DO, *DON'T* ALLOW YOURSELF TO BE *PASSIVELY* AUTORENEWED!

Again, the plans, pricing and tax credits you may be eligible for can change dramatically from year to year even if nothing significant changed at your end (income, household size, etc).

That means that anyone who doesn't log into their account at HealthCare.Gov, CoveredCA.com, etc. enter their current information and actively pick the plan they want next year could end up missing out on hundreds or thousands of dollars in financial help, a better-value plan, or both.

Therefore, I'll say it again: SHOP AROUND!