Open enrollment season began on November 1, 2020, and ends on December 15, 2020! Right now, individuals and families looking for health insurance can find and enroll in, high-quality coverage through Healthcare.gov (or their state’s marketplace). Coverage will start on January 1, 2021. This coverage includes protections for people with pre-existing conditions, as well as a robust set of essential health benefits, such as preventive services, prescription drugs, maternity care, behavioral health services, and COVID-19 testing and treatment.
During a pandemic, having comprehensive health coverage is essential. It can help health care consumers afford routine health care services, and more urgent care when they get sick, including care for COVID-19. Comprehensive coverage can also protect consumers’ financial security by preventing them from having to pay high out-of-pocket costs.
Below, we provide important resources you can use to help health care consumers better understand their insurance options and how to enroll in coverage.
Helping Health Care Consumers Evaluate and Find Plans
As a first step, anyone who is looking for a new insurance plan can learn about and apply for both marketplace and Medicaid coverage through Healthcare.gov or through their state’s marketplace. Healthcare.gov will also direct consumers to their state’s marketplace. When applying for coverage, the marketplace screens for eligibility for other coverage, such as Medicaid and the Children’s Health Insurance Program (CHIP). Through these programs, consumers may be eligible for free or low-cost care depending on their income and family size. Individuals and families can also apply directly for Medicaid or CHIP through their state Medicaid agency.
Additionally, for those who currently have COBRA coverage due to losing employer-based health insurance during the COVID-19 pandemic or for any other reason, they now have the opportunity to enroll in a different plan that might provide more affordable coverage.
Consumers with Current Marketplace Coverage
There’s good news for consumers who are already enrolled in marketplace plans: If they don’t choose a new plan or cancel their current plan, they may be reenrolled into the same coverage for 2021. However, we suggest that consumers review 2021 marketplace plans, as there might be new options that are more affordable or better suited to their needs.
Financial assistance is available to help many people afford coverage if they have lost their jobs or incomes during this pandemic, as well as to help many others who have moderate incomes.
Beware of Junk Plans Sold Outside of Healthcare.gov
Watch out for plans that don’t have important consumer protections. This includes short-term health plans, which are sold outside of Healthcare.gov and the state-based marketplaces. Short-term plans don’t generally cover care related to pre-existing conditions or essential health benefits like maternity care or prescription drugs. When picking a plan in a marketplace, consumers are assured that they will get comprehensive plans and not junk insurance.
To ensure that individuals and families get comprehensive coverage, we recommend they visit Healthcare.gov to enroll.
Navigators Are Waiting to Help Consumers Enroll
Navigators, also called enrollment assisters, are available to consumers who are seeking local, unbiased help with enrolling in coverage through Healthcare.gov or their state’s marketplace. Consumers can use the Get Covered Connector from the nonprofit organization Young Invincibles to schedule an appointment with a local application assister.
Medicaid and CHIP Are Available All Year Long
It’s important to remember that individuals and families with very low incomes may be eligible for Medicaid or CHIP. There is no special enrollment period for these programs – people who are eligible can enroll in them at any point during the year through Healthcare.gov or through a state’s marketplace.
More Resources that Advocates and Organizations Can Use to Help Consumers Enroll
Listed below are resources from trusted sources that are designed to guide consumers through the enrollment processes for the marketplaces, Medicaid, and CHIP. We’ve also included resources that promote open enrollment and help enroll consumers in coverage.
Note that it’s very important for consumers to enroll in coverage despite the ongoing court case challenging the Affordable Care Act. That case is now before the Supreme Court, but it has not changed the availability of coverage for 2021.
Direct Assistance for Consumers
- Healthcare.gov: People who are looking to enroll through the federal marketplace should visit Healthcare.gov. In states that run their own marketplace, Healthcare.gov will direct consumers to the appropriate website.
- Find your state marketplace if your state is not using Healthcare.gov.
- Find local assistance from an agent, broker, or assister.
- Get marketplace coverage during the coronavirus pandemic.
- Find resources in other languages.
- Preview plans and prices.
- Healthcare.gov Call Center: Enrollment by phone and more information is also available through the Healthcare.gov call center, toll-free at 1-800-318-2596.
- Healthcare.gov Blog: Healthcare.gov has a blog with enrollment information for consumers. Here are a few posts that may come in handy:
- Kaiser Health News: If consumers have any lingering questions about marketplace enrollment, these invaluable resources are available from the Kaiser Family Foundation. They also have similar resources in Spanish.
- I lost my job due to the COVID-19 pandemic and now I get unemployment benefits. Do those count as income in determining my eligibility for premium tax credits?
- Families USA: Check out our fact sheet, Are You Uninsured During the COVID-19 Crisis?: What You Need to Know About Finding Health Insurance, Getting Tested, and Getting Care. We explain consumer health insurance options, as well as how to get help with paying for COVID-19 testing and hospital care related to COVID-19. This resource is also available in Spanish.
Resources for Advocates and Organizations to Help Consumers Enroll in Marketplace Coverage
From the American Association on Health and Disability:
- For enrollment assisters interested in helping individuals with disabilities sign up, the National Disability Navigator Resource Collaborative provides cross-disability information and support to Navigators and other enrollment specialists.
From the Center on Budget and Policy Priorities:
- For enrollment assisters, advocates, and people wanting to learn more about enrolling in coverage, watch the Beyond the Basics Webinar Series, which provides training and resources that answer more complicated questions beyond what is offered on Healthcare.gov.
- This blog post has information on how 2020 plans and prices compare with what is being offered for 2021.
From the Center on Health Insurance Reforms:
- For enrollment assisters, check out this Navigator Resource Guide, which summarizes federal policy and any recent changes. It also has state-specific guidance on policies that affect eligibility for enrolling in coverage.
From the Centers for Medicare and Medicaid Services (CMS):
- For enrollment assisters and navigators, check out their COVID-19 Fact Sheet for Assisters.
From Community Catalyst:
- For advocates, this Outreach Hub compiles a variety of useful, unbranded materials in one place. These materials include health insurance literacy guides, social media graphics, one-pagers, fact sheets, videos, messaging guidance and other resources to help spread the word about open and special enrollment periods.
From Get America Covered:
- For advocates and navigators, check out their Open Enrollment: By the Numbers cheat sheet, which summarizes enrollment numbers over the last open enrollment periods and links to state-based marketplaces.
- Get America Covered surveyed people with and without health coverage and found that there is a strong demand for health insurance and high satisfaction with marketplace coverage.
- For enrollment assisters and navigators who want to help LGBTQ+ individuals enroll in coverage, sign up through Out2Enroll to start the enrollment assister training program.
- Their toolkit includes hashtags, key dates, messaging, printable materials and social media shareable materials. This toolkit focuses on helping people in the LGBTQ+ community understand their enrollment options.
- A week-by-week content calendar provides images and suggests language for each week of open enrollment.
From Transform Health:
- For enrollment assisters, this Virtual Outreach and Enrollment Workflow explains the overall steps within the enrollment process for open enrollment and special enrollment periods.
From Young Invincibles:
- For navigators interested in helping younger consumers sign up, this toolkit provides resources, suggested messaging, and OE8 graphics to engage young consumers and help them understand their coverage options for 2021. These resources are available in English and Spanish.
- Do you have a personal story about open enrollment? Submit your experiences at the Get Covered Story hub.
- Consumers of all ages can use the Get Coverage Connector to find application assisters near them.