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Health Insurance Open Enrollment 2021: What you need to know

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Open enrollment is a time to make changes to your health insurance plan or to buy a different one. 

When open enrollment is for you depends on how you get insurance.

  • Most people get their insurance through an employer. Open enrollment for businesses varies. The company makes that decision. Check with your health resources department to find out when your company holds open enrollment. 
  • Medicare recipients have to choose between Oct. 15 and Dec. 7 or during a more limited open enrollment from Jan. 1 to March 31.
  • Most people who get individual insurance or through the Affordable Care Act (ACA) exchanges have between Nov. 1 and Dec. 15. There are a handful of states though that have their own open enrollment period. 

Affordable Care Act open enrollment is usually Nov.1-Dec.15

Open enrollment for plans through the Affordable Care Act starts Nov. 1 and goes through Dec. 15, 2019. In order to get coverage to start on Jan. 1, you'll need to select a plan by Dec. 15

Some states have longer open enrollment periods: 

  • California – Nov. 1, 2020-Jan. 31, 2021
  • Colorado – Nov. 1, 2020-Jan. 15, 2021
  • D.C. – Nov. 1, 2020-Jan. 31, 2021
  • Massachusetts – Nov. 1, 2020-Jan. 23, 2021
  • Minnesota – Nov. 1, 2020-Dec. 22, 2020
  • Nevada – Nov. 1, 2020-Jan.15, 2021
  • New Jersey -- Nov. 1, 2020-Jan. 31, 2021
  • New York – Nov. 1, 2020-Jan. 31, 2021
  • Rhode Island – Nov. 1, 2020-Dec. 15, 2021

What are your health insurance options?

Depending on your situation, you have the following options during open enrollment:

Renew your current policy

You can keep your current health insurance as long as it's still offered. You may not have to do anything if you want to keep what you have. But your current plan may be changing. Watch the mail for a letter about any changes your plan intends to make in 2021.

Changes might not be acceptable to you. For instance, your doctor leaving a plan's provider network or your medications not being covered any longer. You want to look for a plan that better suits your needs. If you need to switch, open enrollment is the time.

Buy an individual policy through a marketplace or directly from an insurance provider

You can buy an individual health plan through the ACA marketplace or directly from an insurance provider. 

ACA plans are eligible for tax subsidies -- plans bought directly from an insurance provider outside of the ACA marketplace aren't eligible for those subsidies. 

Qualifying depends on your family size and income and your family income must fall between 100% and 400% of the federal poverty level (FPL). 

Based on this formula, for 2021 coverage for a family of four, the income bracket between 100% and 400% is $26,200 to $104,800.

Find out more about ACA subsidies.

Another option is Medicaid for people who have lower incomes. More than three dozen states expanded Medicaid eligility. Those states let people with incomes 138% of the federal poverty level to get Medicaid. 

Make changes to your employer-based group health insurance

If you get your health insurance through your employer, the open enrollment period for the government-run marketplaces and Affordable Care Act plans won't affect you.

You need to sign up for coverage during your employer's open enrollment period. 

Employers often change health insurance providers, so make sure you review your offerings. It likely changed since last year. Ask your employer its rules so you know what you have to do.

Change your Medicare plan

If you are enrolled in Medicare and want to make a change in your plan – such as switching to Medicare Advantage (Part C) or adding prescription drug coverage (Part D) – you must sign up during its open enrollment period.

Medicare open enrollment is Oct. 15 to Dec. 7, and coverage starts Jan. 1. 

There is a more limited open enrollment from Jan. 1 to March 31 when you can either switch Medicare Advantage plans or move from Medicare Advantage to Original Medicare. 

Again, open enrollment for the government-run marketplaces doesn't affect you.

Buy a short-term health plan

Short-term health insurance plans were previously only available to young people or those who couldn't afford any other kind of health insurance. Now, most people have access to short-term plans. 

These plans aren't nearly as generous as ACA plans. They don't have to cover basic services, such as maternity, prescription and mental health. So, you need to dig into a plan's specific coverage before going with a short-term plan. 

A benefit of short-term insurance plans is that they're much cheaper than other plans. However, they don't offer as much coverage so you may get stuck paying with more or all of healthcare costs for some services. 

How to select a health plan

If you're buying a health plan through the ACa marketplace, you have a choice of four metal levels:

  • Bronze
  • Silver
  • Gold
  • Platinum

The metal tier varies by premiums and out-of-pocket costs. Bronze plans have the highest deductibles and copays while Platinum have the lowest. However, the premiums for the Bronze plans are lowest and premiums are the highest for Platinum.

Open enrollment

The most popular plan in the individual market is Bronze. Forty-two percent have a Bronze plan. Silver came in second with 34%. Fourteen percent have Gold plans and only 2% chose a Premium plan, according to eHealth.

When deciding what's the best plan for you, think about your health and your family's health -- and financial situation.

Do you see a doctor or other health care provider regularly to help you manage a chronic disease or condition? Do you take costly medications? You may want a health plan that has lower copays and deductibles if you're a frequent user of services.

If you're young and healthy and use few medical services, you may want a plan that costs less in premiums, such as a Bronze or Silver plan. Of course, you never know what can happen. And you can't change your plan outside open enrollment just because something happened to you.

Look at the out-of-pocket maximums for the plans you're considering.

  • Could you afford the premiums? 
  • Could you pay the out-of-pocket costs and deductibles if you need care? 
  • Are your doctors and hospitals in the plan's network?
  • Do you mind getting a referral to see a specialist? 
  • Do you want flexibility to see providers outside of your network? 

Once you answer these questions, you can compare plans and see what's best for you. 

Another decision to make deals with benefit design. 

The three most common types of plan design in the ACA marketplace are health maintenance organization (HMO), exclusive provider organization (EPO) and preferred provider organization (PPO) plans. 

Here's the break down by plan type, according to eHealth:

  • HMOs -- 49% of ACA plans (down from 56% in 2019)
  • EPOs -- 33% of ACA plans (up from 26% in 2019)
  • PPOs -- 16% of ACA plans (the same percentage as 2019)

PPOs are usually more expensive and don't require doctor referrals to see specialists. PPOs also allow you to get care outside of your provider network -- though at a higher price than in-network. HMOs and EPOs don't pay for care outside of provider networks. 

How much are ACA plan premiums?

Premiums for individual coverage for a single person increased by $6 to $456 in 2020. 

eHealth said the average premiums for individual coverage were:

  • Bronze -- $448 (an $8 average increase from 2019)
  • Silver -- $483 (a $2 average increase from 2019)
  • Gold -- $596 (a $27 average decrease from 2019)
  • Platinum -- $732 (a $26 increase from 2019)

For family coverage, the average premiums were:

  • Bronze -- $1,041 (a $39 average decrease from 2019)
  • Silver -- $1,212 (a $32 average increase from 2019)
  • Gold -- $1,437 (an $11 average increase from 2019)
  • Platinum -- $1,610 (an average $150 increase from 2019)

For 2021, the Centers for Medicare and Medicaid Services estimated that the average ACA federal exchange plans premiums in the second lowest cost Silver plan will decrease by 2% for a 27-year-old in 2021. Many states will see even larger premium decreases.

Meanwhile, ACA plan deductibles will continue to climb. Deductibles are what you have to pay before your health plan starts paying for health care services. 

Here are the median individual deductibles for 2021:

  • Bronze -- $6,992 (an increase from $6,755 in 2020)
  • Silver -- $4,879 (an increase from $4,630 in 2020)
  • Gold -- $1,533 (an increase from $1,432 in 2020)

CMS didn't provide deductible estimates for Platinum plans. 

What the health plan will cover

Under the Affordable Care Act, plans must provide at least 10 essential benefits:

  • Outpatient care including chronic disease management
  • Emergency care
  • Hospitalization
  • Pregnancy and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitation services and devices
  • Lab tests
  • Preventive and wellness services
  • Dental and vision care for children

Insurance plans can offer benefits in addition to the required benefits. The best way to find out what benefits each plan covers is to go to its website and compare.

What if you don't want health insurance?

If you don't sign up for health insurance during the open enrollment period, you may have to wait an entire year to sign up. The exception is if you have a qualifying life event that would spark a special enrollment period. 

Something important to remember: You no longer get penalized at tax time for not having health insurance. Congress eliminated that mandate's tax penalty. 

However, a handful of states have their own individual mandate: 

  • California
  • District of Columbia
  • Massachusetts
  • New Jersey 
  • Rhode Island
  • Vermont

You may be fined at tax time if you don't have health insurance in those states. 

    Special enrollment for health insurance

    You need to sign up for health insurance during open enrollment, but there are a limited number of ways that you can get health care during other parts of the year. If you don't enroll during open enrollment, you're eligible for a special exception enrollment period if:

    • You get married
    • You get divorced and were getting your health insurance through your spouse's employer
    • You have a baby or adopt a baby or place a child for adoption or foster care
    • Your spouse or partner dies and that leaves you without health insurance
    • Your spouse or partner loses a job and you had coverage through his or her work
    • You lose your job and had coverage through your work
    • Your hours are cut and you are no longer a full-time employee eligible for workplace coverage
    • You are in an HMO and move outside its coverage area
    • You leave jail or gain citizenship

    If you voluntarily drop your coverage, you won't qualify for a special enrollment period. The only time you can re-enroll is during open enrollment.

    If you apply for a special exception and are rejected, you can appeal the decision to the Health Insurance Marketplace.

    What's the difference between an HMO, PPO, HDHP, EPO and POS? Find out here.

    Where can you learn more?

    HealthCare.gov has a list of important marketplace deadlines and information about eligibility. You also can sign up to get emails about new health insurance options and benefits.