Uninsured in the Pandemic? Here’s How to Navigate the Reopened ACA Marketplace

In January, the President signed an executive order to reopen up the federal health insurance marketplace for three months, from February 15th through May 15th, 2021 so those who want to change their marketplace coverage, or sign up for new coverage, can do so. This is also known as a Special Enrollment Period or SEP. An SEP is a time frame in which you have special permission from the Marketplace to sign up for coverage or make changes to current coverages outside of the normal Open Enrollment Period, which is usually in November. 

When can consumers sign up, and in which states? 

The sign-up window will be open for three months, from Monday February 15th, through May 15th, 2021. Uninsured residents of any of the 36 states that use the federal healthcare.gov platform can look for plans during that time and enroll. 

States and the District of Columbia that operate their own marketplaces are establishing special enrollment periods similar to the new federal one, though they may have somewhat different time frames or eligibility rules. 

Can people who lost their jobs and health insurance many months ago sign up during this new Enrollment Period?

Yes. The enrollment window is open to anyone who is uninsured and would normally be eligible to buy coverage on the exchange (people who are serving prison or jail terms and those who are in the country without legal permission are not allowed to enroll). 

People with incomes up to 400% of the federal poverty level, are eligible for premium tax credits that may substantially reduce their costs. 

Typically, people can purchase a Marketplace plan only during the Annual Open Enrollment Period in the fall, or if a major life event gives them another opportunity to sign up, called a Special Enrollment Period. Losing job-based coverage is one event that creates a special sign-up opportunity; so is getting married, or having a baby. Typically, people must sign up with Marketplace within 60 days of the event.

With this new Special Enrollment Period, how long someone has been uninsured isn’t relevant, nor do people have to prove documentation that they have lost job-based coverage. The message is quite simple: “Come and Apply.” 

What about people who are already enrolled in a Marketplace plan? Can they switch their coverage during this new enrollment?

Yes, as long as their coverage is through the federal marketplace. If, for example, someone is enrolled in a gold plan now but what’s to switch to a cheaper bronze plan with a higher deductible, that’s allowed. As mentioned above, however, some state-operated marketplaces may not make that option available. 

Many people have lost significant income during the pandemic. How do they decide whether a marketplace plan with premium subsidies is a better buy for them than Medicaid?

They don’t have to decide. During the application process, the marketplaces asks people for income information. If their annual income is below the Medicaid threshold (for many adults in most states, 138% of the federal poverty level, or about $18,000 for an individual), they will be directed to that program for coverage. If people are eligible for Medicaid, they can’t get subsidized coverage on the exchange.

People can sign up for Medicaid anytime; there is never a need to wait for any annual or special enrollment period. 

Those already enrolled in a Marketplace plan whose income changes should go back into the marketplace and update their income information as soon as possible. They may be eligible for larger premium subsidies for their marketplace plan, or if their income has dropped significantly, for Medicaid. (Likewise, if their income has increased and they don’t adjust their marketplace income estimates, they could be on the hook for overpayments of their subsidies when they file their taxes. 

What about people who signed up for COBRA to continue their employer coverage after losing their job? Can they drop it and sign up for a marketplace plan?

Yes, people in federal marketplaces states can take that step, health experts say. Under COBRA, people can be required to pay the full amount of the premium plus a 2% administrative fee. Marketplace coverage is almost certainly cheaper. 

Normally, if people have COBRA coverage and they don’t drop by midyear, they can’t sign up for a marketplace plan until the annual fall open enrollment period. However, this special enrollment period will give people that option. 

It is always recommended to have a licensed and professional health insurance expert review your current or potential Health Care Plans, as they can assist you in quoting, choosing a plan that best suits your budget and desires, they can research coverage benefits and narrow down your options based on your needs, assist you in enrolling start to finish as well as assist you throughout the year for claims and other benefit related concerns as a point of contact! Health Insurance Brokers are able to offer this assistance without any cost from the consumer, as they are paid by the insurance companies directly, not by the consumer signing up for insurance. 

Group Plans Inc has been managing the health risk of our community since 1977 and we take pride in assisting our clients to obtain the best coverage options available. Please contact us to schedule an In-Person Appointment, Phone Appointment, or Virtual/Video Appointment! (623) 889-7600


Source: KHN Kaiser Health News