Mariah Baker, National Center for Health Research
If you don’t have health insurance, lost your health insurance, or want a new, more affordable plan, you can purchase insurance through the Affordable Care Act (“ACA” or “Obamacare”) on what is called the marketplace or the exchange.
In previous years, people could only enroll in marketplace plans during the open enrollment period (approximately Nov. 1st – Dec. 15th) or within 60 days of a “qualifying life event” such as job loss, having a baby, or getting married or divorced.1 Fortunately, in response to the COVID-19 pandemic, President Biden has signed an executive order to reopen the ACA marketplace starting February 15th, 2021 and ending August 15th, 2021.2 This 2021 Special Enrollment Period only applies to the 36 states with federally-run insurance marketplaces. However, 14 states and Washington, DC have their own special enrollment periods, which are listed here:
- California’s enrollment period is currently open and will close May 15th, 2021. You can find the California state marketplace here.
- Colorado’s enrollment period is currently open and will close May 15th, 2021. You can find the Colorado state marketplace here.
- Connecticut’s enrollment period is currently open and will close April 15th, 2021. You can find the Connecticut marketplace here.
- The District of Columbia has extended their open enrollment period through the duration of the COVID-19 pandemic. You can find the District of Columbia marketplace here.
- Idaho’s enrollment period will reopen March 1st, 2021 and close March 31st, 2021. You can find the Idaho marketplace here.
- Maryland’s enrollment period is currently open and will close May 15th, 2021. You can find the Maryland marketplace here.
- Massachusetts’ enrollment period is currently open and will close July 23rd, 2021. You can find the Massachusetts marketplace here.
- Minnesota’s enrollment period is currently open and will close May 17th, 2021. You can find the Minnesota state marketplace here.
- Nevada’s enrollment period is currently open and will close May 15th, 2021. You can find the Nevada marketplace here.
- New Jersey’s enrollment period is currently open and will close May 15th, 2021. You can find the New Jersey marketplace here.
- New York’s enrollment period is currently open and will close May 15th, 2021. You can find the New York marketplace here.
- Pennsylvania’s enrollment period is currently open and will close May 15th, 2021. You can find the Pennsylvania state marketplace here.
- Rhode Island’s enrollment period is currently open and will close May 15th, 2021. You can find the Rhode Island state marketplace here.
- Vermont’s enrollment period is currently open and will close May 14th, 2021. You can find the Vermont marketplace here.
- Washington’s enrollment period is currently open and will close May 15th, 2021. You can find the Washington state marketplace here.
State marketplaces may have different requirements for eligibility than those that are federally-run.
Why Is this Enrollment Period so Important?
In the United States, almost 50% of people obtain health insurance through their employer, but about 10% of people don’t have any health insurance at all.3 COVID-19 has left many people unemployed, which means they may have lost their health insurance benefits. All of this is happening during a global pandemic where people are much more likely to get sick and need medical care. This special enrollment period attempts to make sure as many people as possible will have health insurance and can get quality health care this year.
Applying for Coverage
When applying for coverage through the marketplace, you will need to provide information about members in your household, your employer, and your household income. Here is a checklist to help you get ready to apply. It is important to make sure that your income is as accurate as possible, as that will determine how much you pay for coverage.
Based on your income and household size, you may be eligible for premium tax credits or cost-sharing reductions. Premium tax credits make your monthly payments smaller, and cost-sharing reductions mean you pay less out-of-pocket when you visit a provider (a smaller co-payment). You can use this tool to see if you may qualify for a premium tax credit or cost-sharing reductions.
Plan Types and Coverage Start Dates
There are four main plan types, Bronze, Silver, Gold, and Platinum, and they differ in terms of how much you pay monthly versus how much you pay when seeing a provider.4 For example, in the Bronze plan, your monthly payment will be lower, but your co-payment will be greater. If you choose a Platinum plan, your monthly payment will be much more expensive, but you will pay less out-of-pocket when you receive medical care. If you qualify for cost-sharing reductions, you must choose a Silver plan to get the savings.4 Find more about picking a plan here.
If you are applying for a marketplace plan for the first time, you will have 30 days after you apply to choose a plan.5 If you are already enrolled in a marketplace plan, you will be able to change to any available plan in your area.5 Coverage will begin the first day of the month following enrollment. For example, if you enroll on February 16th, 2021, your coverage will begin March 1, 2021.2
If you begin an application in the ACA marketplace and you qualify for Medicaid or Children’s Health Insurance Plan (CHIP), you will be transferred to your state’s website for Medicaid and CHIP, where you can fill out an application.5
Tips for Enrolling in Marketplace Plans
- Each year, health insurance companies make changes to their benefits, premiums, deductibles, and co-payments. During enrollment, you can enroll in a health insurance plan that fits your needs. Here are some key terms to know as you are looking through plans:
o Premium: the amount you pay for your health insurance every month.
o Deductible: the amount you pay for covered health care services before your insurance plan starts to pay.
o Copay: a fixed amount you pay for a covered health care service after you pay your deductible. Do your homework.
- Reviewing your options could save you hundreds or thousands of dollars. Even if you liked a plan in the past, it might not be the best choice for you now. For example, it might be cheaper for your children to be on your spouse’s insurance plan instead of yours.
- Double-check that the medications you are taking and the doctors you see are covered by the plan you choose. Choosing a cheaper plan could cost you more in the long run if your doctor is out-of-network or if your plan doesn’t cover something you need, such as a smoking cessation drug. Most insurance companies have a website where you can check which doctors and medications are covered.
- Check that the services you need are covered. Are you going to need specific services that some insurance plans exclude, such as bariatric surgery, certain types of counseling or smoking cessation programs, or surgery to fix complications from cosmetic surgery? These exclusions are often hard to find – and you may not know they aren’t covered until you need them and get denied. Before signing up, you should call the insurance company to find out what is covered and what isn’t.
- Don’t forget about vision and dental plans. These plans cover preventive services like eye exams and teeth cleaning. Some plans include dental benefits. You can also buy these plans separately through the exchange. Some plans on the exchange include vision benefits. If your insurance covers anyone under the age of 18, they must offer dental and vision coverage. Routinely getting your teeth and eyes checked could help prevent more serious medical problems down the road. On the other hand, these plans might cost more than they are worth to you, so consider your own needs before deciding.
- Signing up for coverage is easy: It takes about 10 minutes to submit an application. You can even sign up on your smartphone! There are tools to help you look up doctors and prescription drugs, so you can figure out which plans will cover your needs.
- Free, expert help is available: Free, anonymous help is available 24/7 if you want to talk to someone about your options or have questions about signing up. You can call 1-800-318-2596, or you can find local help by searching on HealthCare.gov.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff
The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.
- Special Enrollment Period (SEP) – HealthCare.gov Glossary. HealthCare.gov. https://www.healthcare.gov/glossary/special-enrollment-period/.
- Department of Health and Human Services. 2021 Special Enrollment Period Access Extended to August 15 on HealthCare.gov for Marketplace Coverage. https://www.hhs.gov/about/news/2021/03/23/2021-special-enrollment-period-access-extended-to-august-15-on-healthcare-gov-for-marketplace-coverage.html Published March 23rd, 2021.
- Health Insurance Coverage of the Total Population. KFF. https://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22%3A%22Location%22%2C%22sort%22%3A%22asc%22%7D. Published October 23, 2020.
- Understanding Marketplace health insurance categories. HealthCare.gov. https://www.healthcare.gov/choose-a-plan/plans-categories/.
- Center for Medicare and Medicaid Services. Fact sheet 2021 Special Enrollment Period in response to the COVID-19 Emergency. CMS. https://www.cms.gov/newsroom/fact-sheets/2021-special-enrollment-period-response-covid-19-emergency. Published January 28, 2021.