Health care reform has been a big topic in the news for a while now. With so much news on the topic, it can get confusing, especially during the federal Health Insurance Marketplace’s (Healthcare.gov) open enrollment.
Here are some things to know about health care for 2021.
What Is Open Enrollment?
Open enrollment refers to the time period when you can add or change your health insurance. Outside of that time frame, you can only make changes if you have a certain change in circumstance, like getting married or having a baby.
When Is the Marketplace’s Open Enrollment Period?
If you plan to apply for health coverage through the Affordable Care Act (ACA) on Healthcare.gov, you can sign up or change your plan from Nov. 1, 2020, through Dec. 15, 2020. Your coverage will begin on Jan. 1, 2021.
There Was a Lot of News a Few Years Ago About Repealing the ACA. Was It Repealed?
No. Two bills to repeal the ACA were introduced to the Senate in 2017, but they did not pass. The ACA is still in effect.
What About the Court Case Challenging the ACA That Is Going Before the Supreme Court?
On Nov. 10, 2020, the U.S. Supreme Court will decide if the ACA is constitutional in the case, California v. Texas. The ACA does remain in effect while the case is being decided. But the outcome of this court decision could have sweeping impacts.
According to the Kaiser Family Foundation, the parts of the ACA that could be removed include:
- Protections for people with pre-existing conditions
- Assistance to make individual health insurance more affordable
- Expanded eligibility for Medicaid
- Coverage of young adults up to age 26 under their parents’ insurance policies
- Coverage of preventive care with no patient cost-sharing
- Closing of the doughnut hole under Medicare’s drug benefit
- A series of tax increases to fund such initiatives
Though the case will be argued on Nov. 10, 2020, a decision in the case may not come until June 2021.
But Weren’t There Some Changes to the Original Law?
Yes. The president signed an order to make some changes to the ACA. The order included changes to assistance payments to insurance companies, limits on short-term policies and how small businesses can buy policies. For individuals applying for coverage, the ACA is still the same.
If you do not buy a policy through the federal government's Marketplace, you might see short-term policies offered as an option. The policies may not have the same benefits and coverage as Marketplace policies. For example, they may not cover pre-existing conditions. And when the plan expires, you will not be able to switch to an ACA policy outside of the annual open enrollment period. The expiration of a short-term policy is not considered a qualifying life event.
Because of these new terms on short-term policies, make sure you are getting the coverage you need when you are shopping for non-Marketplace policies, even if they are offered through your employer.
I Live in Georgia and I just Heard That I Cannot Access Healthcare.gov Anymore. What Happened?
On Nov. 1, 2020, Governor Kemp's plan to remove Healthcare.gov as an enrollment option was approved by federal officials. This does not change anything this year. But as of 2023, Georgia residents will no longer be able to enroll for health care coverage through marketplace. You will still be able to acquire heath care coverage though private brokers and private insurers.
Georgia will be the only state that does not have a government-run website to enroll in ACA coverage.
Will I Pay a Penalty If I Don't Buy Health Insurance?
As 2019, you no longer have to pay a tax penalty if you are uninsured. But you might still be subject to a state tax penalty.
What Are the Essential Terms I Need to Know?
When you review your options for health insurance, there are some terms you need to know so you can make the best decision for you and your family.
Your monthly premium is what you pay each month for the cost of your plan.
There are also costs you pay each time you need care. These are called
Out-of-pocket pocket costs include:
- Deductibles: What you pay each year before your insurance begins paying.
- Co-payments: What you pay to see a health care provider. For instance, your co-pay for your primary care doctor might be $15 and your asthma specialist might be $30.
- Coinsurance: The percentage of your bill you must pay.
Covered services means what your health plan will pay for. This includes medical treatments and prescription medicine.
Finally, know which doctors, specialists and other health care providers are in-network or out-of-network.
In-network means your health plan has an agreement with that provider for your health care. Co-payments and other costs are generally less expensive if you use in-network providers.
Out-of-network means there is no agreement between the health insurance company and the provider. Your costs will be higher to see a health care provider out of network.
For more insurance definitions, see the glossary of common terms on fairhealthconsumer.org.
How Does This Affect Me If I, or Someone in My Family, Have Asthma or Allergies?
Under the ACA, the protections for people with preexisting conditions still exist if they buy a plan from the Marketplace. That means if you have asthma and allergies, you cannot be denied coverage or forced to pay more for coverage because of your condition.
Will My Asthma and Allergy Medicines Be Covered?
As you shop for plans, look for a medicine list called a formulary. This is a list of medicines covered on that plan. Check your preferred plan’s list for medicines you take before you sign up.
Many questions remain about health care coverage in the future. But for now, the ACA is still the same for individuals seeking coverage. If you are applying for or changing your plan, it is best to start now. Open enrollment is shorter this year, giving you less time to find the policy that works best for you.
How Can I Get Help If I Have Questions?
There are free tools on HealthCare.gov and personal assistance in many communities available to make sure you feel confident you’ve picked the right plan for you and your family. If you have questions about signing up or want to talk through your options with a trained professional, you can get free and confidential assistance:
- Online: Information is available at HealthCare.gov CuidadoDeSalud.gov.
- By phone: Marketplace call center representatives are available to help all day, every day at 1-800-318-2596. TTY users should call 1-855-889-4325. Assistance is available in many languages. The call is free.
- In person: Consumers can find free and confidential local help in their communities by visiting LocalHelp.HealthCare.gov or you can make an appointment with the Get Covered America Connector.
Updated November 2020