Oh, yeah: Open Enrollment is happening NOW! Here's 7 important things to remember.

Fri, 10/30/2020 - 12:19am

There's a lot on everyone's plate at the moment. A global pandemic which has already killed over 230,000 Americans and infected 9 million more. The entire West Coast is on fire while the Gulf Coast is being hit with hurricanes. And there's some sort of election coming up on Tuesday, I hear.

Meanwhile, in just eleven days the Republican-controlled Supreme Court will hear oral arguments in a case brought by Republican plaintiffs (and sided with by a Republican Justice Department) over whether the Affordable Care Act should be struck down en masse because a Republican-controlled House and Republican-controlled Senate decided to change the individual mandate penalty amount from $695 to $0.

However, there's one other important thing happening with the ACA in just two days: The 2021 ACA Open Enrollment Period begins on Sunday, November 1st.

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 2021 enrollment period and/or to particular states.

1. DON'T MISS THE DEADLINE!

California technically launched Open Enrollment for 2021 (for current enrollees to re-enroll only) a month ago, on October 1st, 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, 2021, but many states which operate their own ACA exchanges have extended deadlines:

  • California: January 31st, 2021
    • enroll by 12/15 (update: 12/30) for coverage starting January 1st
    • enroll from 12/16 - 1/15 for coverage starting February 1st
    • enroll from 1/16 - 1/31 for coverage starting March 1st
  • Colorado: January 15, 2021
    • enroll by 12/15 for coverage starting January 1st
    • enroll from 12/16 - 1/15 for coverage starting February 1st
  • District of Columbia: January 31, 2021
    • enroll by 12/15 for coverage starting January 1st
    • enroll from 12/16 - 1/15 for coverage starting February 1st
    • enroll from 1/16 - 1/31 for coverage starting March 1st
  • Massachusetts: January 23, 2021
    • enroll by 12/23 for coverage starting January 1st
    • enroll between 12/24 - 1/23 for coverage starting February 1st
  • Minnesota: December 22, 2020
  • Nevada: January 15, 2021
    • enroll by 12/15 for coverage starting January 1st
    • enroll from 12/16 - 1/15 for coverage starting February 1st
  • New Jersey (new!): January 31st, 2021
    • enroll by 12/15 for coverage starting January 1st
    • enroll from 1/01 - 1/31 for coverage starting March 1st
  • New York: January 31, 2021
    • enroll by 12/15 for coverage starting January 1st
    • enroll from 12/16 - 1/15 for coverage starting February 1st
    • enroll from 1/16 - 1/31 for coverage starting March 1st
  • Pennsylvania (new!): January 15, 2021
    • enroll by 12/15 for coverage starting January 1st
    • enroll from 12/16 - 1/15 for coverage starting February 1st
  • Rhode Island: January 23rd, 2021
    • enroll by 12/31 for coverage starting January 1st
    • enroll from 1/01 - 1/23 for coverage starting February 1st
  • Washington State: January 15th, 2021
    • enroll by 12/15 for coverage starting January 1st
    • enroll from 1/01 - 1/15 for coverage starting February 1st

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.

NEW JERSEY and PENNSYLVANIA residents: Remember that both of these states have split off from HealthCare.Gov onto their own fully state-based ACA exchange websites!

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

One of the most sickly ironic things about the ACA being in jeopardy due to the federal individual mandate penalty being zeroed out is that there are actually five states which have reinstituted their own healthcare coverage requirement:

  • 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 2021 EVEN IF YOU DIDN'T IN 2020...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 $1,080 for a single person or $1,800 for a family of four.
  • That means that if your household income is only a little over the 400% FPL line in 2020 and doesn't change much, you may end up qualifying in 2021 after all. For instance, if you're single and earn exactly $50,000 this year, you don't qualify for credits since the cut-off is $49,960...but if you earn exactly $50,000 in 2021, you likely would qualify next year because the cut-off will be $51,040. This seemingly small change could save you thousands of dollars in premiums.

Therefore, it's vitally important that everyone visit HC.gov (or their state exchange website) & plug in their projected 2021 info to see whether they qualify or not.

5. RESIDENTS OF FOUR STATES MAY QUALIFY FOR ADDITIONAL SUBSIDIES!

Federal ACA exchange subsidies to cut down on premiums are available, on a sliding scale, to households earning between 100 - 400% of the federal poverty line (up to around $51K for a single person or around $105K for a family of four). Addional subsidies to cover deductibles and other out-of-pocket costs are available to households earning 100 - 250% FPL.

There are four states which are offering additional subsidies to exchange enrollees, however:

  • CALIFORNIA
  • MASSACHUSETTS
  • NEW JERSEY
  • VERMONT

Vermont and Massachusetts have had their state-based subsidy programs in place since the very first Open Enrollment Period in 2014, available to enrollees earning less than 300% FPL. Massachusetts actually has a whole different category of exchange policies for this population called ConnectorCare, while Vermont quietly tacks their subsidies on to regular ACA plans.

California launched their state subsidies in 2020. In their case, they enhance subsidies modestly for those earning 200 - 400% FPL while also extending new subsidies to those earning 400 - 600% FPL (up to around $76K if you're single or $157K for a family of four).

Starting in 2021, along with New Jersey's new state-based exchange, they're also offering additional subsidies to all exchange enrollees earning 100 - 400% FPL. For the first year of the program the state is simply dividing the funds up evenly among all on-exchange enrollees evenly, which they figure will come to between $564 - $840/year apiece, or roughly $47 - $70/month. This should bring many people's net premiums down to $0 (I'm assuming that it won't result in negative premiums, though it's conceivable this could happen for the first year given the lack of a sophisticated mechanism to calculate how much everyone is supposed to receive).

6. VIA SILVER LOADING, SOME SUBSIDIZED ENROLLEES MAY BE ABLE TO GET ZERO-PREMIUM BRONZE PLANS...OR EVEN ZERO-PREMIUM GOLD PLANS!

  • As I explain here, nearly every state have loaded the full Cost Sharing Reduction (CSR) amount 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. The end result of this means subsidized enrollees may end up getting a Gold plan for less than Silver, or a Bronze plan dirt cheap (or even free!). In fact, depending on where they live and what their household makeup is, some people will even qualify for a zero-premium GOLD plan!

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!

ONE MORE THING: There's no way of avoiding the elephant in the room. Yes, it's entirely possible that the Affordable Care Act itself will be struck down by the U.S. Supreme Court sometime next spring...and yes, it's conceivable that if this happens, it could potentially mean ACA subsidies and even the policies themselves could be terminated effective immediately. Many people are probably wondering whether they should bother enrolling this fall if their policy could be cut off anyway.

My response is that yes, if you were already planning on enrolling in an ACA exchange plan, you should still do so during Open Enrollment, for several reasons:

  • First, because the Supreme Court could very well rule against the plaintiffs in the Texas Fold'em lawsuit after all, even with Amy Coney Barrett. Via the L.A. Times:

Just one week before the death of Justice Ruth Bader Ginsburg, whom she has been nominated to replace, Barrett participated in a mock court hearing on the pending case. She was part of an eight-judge panel that heard the mock arguments, conducted at William & Mary Law School.

None of the judges ruled in favor of the administration and Republican states’ request to strike down the law.

Five of the judges ruled that one part of the law — the so-called individual mandate, which Congress has already effectively nullified — was unconstitutional, but that the rest of the healthcare law could stay in place. The other three judges would have thrown out the case, arguing that the conservative states challenging the law did not have standing to bring the suit.

It's not known which group Barrett was part of, but either way, in a mock version of the case, at least, she ruled that either the case had no merit or that the penalty was severable from the rest of the law. That doesn't mean she'd rule the same way in the real case, of course, but it lends at least a bit of hope.

  • Second, because if Democrats manage to win a trifecta (White House, House, Senate) next week, they'd have the ability to render the entire lawsuit moot by passing a simple bill which either a) resets the mandate penalty to $1 or higher; b) clearly states that the mandate is severable from the rest of the law; or c) strikes out the underlying mandate language altogether.
  • Third, because there are several possible rulings the Supreme Court could make besides "no merit/severable" or "strike down the entire law". They might kick the whole thing back down to the district level again, which could potentially mean it bounces back & forth between the lower & higher court for another year. Law professor Nicholas Bagley thinks this is highly unlikely, but...it's possible. If that happens, then the ACA should remain in its current state (shaky but still chugging along) for at least another year.
  • Fourth, because even if SCOTUS does strike down the entire law, they might issue a stay of their own decision until at least January 2022. As I noted the other day, this is unlikely, but it's possible.

This means that those enrolling in coverage starting in January will have solid coverage for at least the first four to six months of the year...which is vitally important, especially in the middle of a pandemic which shows no signs of slowing down. Coverage for 4-6 months is still better than for zero months.

So yes, definitely consider enrolling in an ACA exchange plan if you don't have adequate healthcare coverage via Medicare, Medicaid, CHIP or your employer.

OE8

Advertisement