Open enrollment for 2021 individual market coverage—both in the exchange and off-exchange—will begin November 1, 2020, and end just over six weeks later on December 15, in most states (some states have extended enrollment windows, which are discussed below).
This is the same schedule that was used in most states for 2020 coverage. As was the case for 2020, open enrollment in most states will end before the 2021 plans take effect, so enrollees won’t have a chance to change their minds about their coverage after it takes effect.
There are less disturbance and vulnerability in the individual market than there was in the previous few years, and proposed rate increments for 2021 are by and large unassuming, albeit that could change as more rate filings become accessible all through the late spring. As of early July, rate filings had been disclosed in nine states and added up to a normally proposed rate increment of about 2.6%.1
The national government is proceeding to not support cost-sharing decreases, yet that is not, at this point a dubious factor for safety net providers since they realize what’s in store. In practically all states, guarantors are adding the expense of CSR to silver arrangement charges, which brings about bigger premium endowments. As a rule, bronze and gold plans are especially moderate because of the lopsidedly huge sponsorships that can be utilized to counterbalance the expenses (individuals who aren’t qualified for premium appropriations can pick a non-silver arrangement, or, in numerous states, a silver arrangement sold external the trade, and try not to need to pay charges that incorporate the expense of CSR).
After Sharp Reductions in the Past Two Years, Navigator Budget Remained Unchanged for 2020
In the fall of 2017, the Trump administration sharply reduced HealthCare.gov’s marketing budget and cut the budget for Navigator organizations (enrollment assistance) by 41 percent.2 The Navigator budget had been $63 million in the fall of 2016, and was reduced to $36 million in 2017.
In July 2018, CMS announced another drastic cut to the Navigator funding budget, reducing it to just $10 million across all 34 states that receive grants.3 But that amount remained steady in 2019, with another $10 million distributed to Navigator organizations in the weeks leading up to the open enrollment period for 2020 health plans.4
Although Navigator funding was not further reduced in 2019, it remains far below what it was in the past, and there are roughly half as many Navigator organizations as there were before funding was reduced.4
The ostensible justification for the Navigator funding cuts in previous years was based on the fact that Navigators have enrolled a fairly small percentage of the people who have signed up for private plans in the exchanges, and on the assumption that as time goes by, people need less help with the enrollment process.
But as Kaiser Family Foundation points out, public awareness about the enrollment process remains fairly low among people who are uninsured and those who buy their own coverage. And although Navigators don’t enroll large numbers of people in private plans, their assistance is invaluable when it comes to Medicaid enrollment (which isn’t counted when the groups are judged in terms of their total enrollments). And many Navigator organizations also partner with volunteer enrollment counselors, but the enrollments facilitated by those volunteers also are not counted. In short, the assistance provided by Navigators is more than it appears at first glance, and the drastic funding cuts (which were more severe in some states than in others) have reduced the amount of assistance that’s available.
With all that in mind, let’s take a look at what you need to know this fall if you buy your own health insurance in the individual market.
In most states, if you need to buy individual market coverage—on or off-exchange—for 2021, you’ll have a little over six weeks to complete your enrollment or make changes to your existing coverage.
In almost all states, open enrollment will start on November 1 and end on December 15. There are 13 fully state-run exchanges that run their own enrollment platforms and thus have the option to add additional time before or after the regularly scheduled open enrollment period (as described below, this will grow to 14 in the fall of 2020, with the addition of Pennsylvania; New Jersey might also have its own exchange in the fall of 2020).
There are three state-run exchanges (California, Colorado, and DC) where open enrollment has been permanently extended. And Pennsylvania, which will have a state-run exchange for the first time as of the fall of 2020, has announced that open enrollment for 2021 coverage will be extended. In previous years, most of the state-run exchanges have ended up adding extensions to their open enrollment windows, but unless an exchange has announced an extension prior to open enrollment, enrollees should plan to finish the process by December 15, and should not assume that they’ll have extra time after that.
- DC: Open enrollment permanently set at November 1 to January 31.5
- California: Open enrollment permanently set at November 1 to January 31.6
- Colorado: Open enrollment permanently set at November 1 to January 15.7
- Pennsylvania: Open enrollment for 2021 set at November 1 to January 15.8
Once open enrollment ends, you won’t have an opportunity to enroll or make changes to your coverage for 2021 without a qualifying event.
If your insurer exits the market in your area at the end of 2020, you’ll have a special enrollment period (the first 60 days of 2021) during which you can pick a new plan. But as was the case for 2020, it appears this will not be a widespread issue for 2021 (unlike the situation for 2017 and 2018, when numerous carriers exited exchanges across the country).
Pennsylvania Will Have a New Enrollment Platform
There is a health insurance exchange in each state, although most states use the federally-run platform at HealthCare.gov instead of running their own exchange. In the first few years that the exchanges were operational, several states made changes, switching between HealthCare.gov and their own websites.
For 2018 and 2019, there were no changes; all of the states continued to use the same enrollment platforms they had used in 2017. For 2020, Nevada stopped using HealthCare.gov and transitioned to a state-run enrollment platform. And starting in the fall of 2020 (for enrollment in 2021 health plans), Pennsylvania will also stop using HealthCare.gov and begin using its own state-run platform, called Pennie. New Jersey has also indicated a similar plan, although the state has not publicized its transition process and it’s unclear whether that’s still on track for a fall 2020 implementation.9
If you’re in Pennsylvania or New Jersey and currently enrolled in a plan through HealthCare.gov, you’ll want to pay close attention to any communications you receive regarding actions that you might need to take to maintain your coverage for 2021. The rest of the states will continue to use the same exchange enrollment platform that they used for 2020.
The November 1 through December 15 open enrollment window applies to individual market coverage that’s compliant with the Affordable Care Act (ACA, aka Obamacare), both on and off-exchange. But only a very small segment of the population is enrolled in individiual market coverage. There were an estimated 15.1 million people with individual health coverage in 2019, although that analysis included grandfathered plans and short-term health plans10 (open enrollment does not apply to either of those).
There are open enrollment windows that apply to people with Medicare and with employer-sponsored health insurance, but they are separate from the enrollment periods that apply in the individual market, and are not affected by Navigator funding, timing changes, the type of exchange a state uses, or state-specific extensions.
People who have grandmothered or grandfathered individual market coverage are also not affected by any changes related to open enrollment. Those plans are no longer available for purchase and thus do not have applicable open enrollment windows.
However, if you have a grandmothered or grandfathered plan, it’s absolutely in your best interest to see how it compares with the ACA-compliant plans that will be available for 2021, particularly if you’ d be eligible for premium subsidies or cost-sharing subsidies in the exchange.
What to Know Before Enrollment
It’s particularly important that you pay attention to the communications you receive from the exchange—or from your insurer if you have off-exchange coverage. Make sure you understand how much your premium will change for the coming year, and if you have a premium subsidy through the exchange, be sure you’re looking at how much your after-subsidy premium will change, since that’s the amount that you actually pay each month.
Pay attention as well to the coverage details summarized in the renewal information you get from your insurer and/or the exchange. Insurers can terminate a plan at year-end and “crosswalk” or “map” enrollees to a new plan with similar—but not identical—benefits. Exchanges can also do this if an insurer is leaving the exchange altogether.
Prior to 2018, people had a chance to make changes to their coverage in January if they were caught off-guard by a higher premium or coverage changes at the start of the new year. That opportunity is no longer available in most states (since open enrollment ends December 15 in most of the country), so it’s essential to make sure you understand the details before mid-December and make any changes that you deem necessary.
As described above, Navigator funding in most states has been significantly reduced over the last few years, and there aren’t as many enrollment assisters available as there once were. If you think you might need help selecting a plan or enrolling, it’s wise to make an appointment ahead of time with a broker or Navigator in your area or to find out what organizations in your community will have certified enrollment counselors on hand during open enrollment.
Reasons for Shorter Enrollment
It’s important to understand that the shorter open enrollment period, which is part of a market stabilization effort, was actually planned under the Obama administration, and was slated to take effect in the fall of 2018. The Trump administration only moved that up a year, having it take effect in the fall of 2017 instead.
The move to shorten open enrollment starting in the fall of 2017 was part of the market stabilization regulation that HHS finalized in April 2017.11 The idea was that insurers need to have as many people as possible enrolled in full-year coverage in order to keep the risk pool stable, and ending open enrollment before the end of December is the means to achieving that goal.
In previous years, when open enrollment continued into the new year, people could enroll in coverage in late January and have a March 1 effective date. That meant they were only paying premiums for 10 months of the year, rather than 12.
Sick people are not likely to do this. It was healthy enrollees—the people who are most needed in the risk pool in order to keep it stable—who were signing up for partial-year coverage. Insurers and the exchanges knew this wasn’t sustainable and the shorter open enrollment period is a means of addressing the issue.
And again, HHS, under the Obama administration, had come to the same conclusion in regulations that they finalized in early 2016.12 But the plan at that point was to give insurance companies, exchanges, and consumers more time to prepare for the shorter open enrollment period as it wasn’t slated to take effect until the fall of 2018.
Instead, the new dates were rolled out in April 2017, just a little over six months before the start of open enrollment for 2018 coverage.
it’s also essential to note that the Obama administration was not planning to cut funding for exchange marketing and enrollment assistance, which the Trump administration did in tandem with the expedited shortening of the enrollment period.
Understanding the Controversy
The concept of a shorter open enrollment period that ends in December, with all plans effective January 1, was controversial even when HHS under the Obama administration proposed it in late 2015. HHS discussed the dissenting opinions in the regulation that they finalized in early 2016.
Proponents of a shorter open enrollment period note that it helps to ensure that everyone has full-year coverage. They also believe that a three-month enrollment window is no longer necessary now that the exchanges are functioning smoothly and insurers and consumers are used to the new normal in the individual market.
But opponents of the shorter open enrollment window note that the individual market is volatile, which means that people cycle in and out of it from one year to the next and there are constantly new people needing to purchase individual market coverage for the first time. They also point out that the November 1-December 15 window overlaps with the existing Medicare open enrollment period. And since many of the brokers who assist people in the individual market are also helping people in the Medicare market, the assistance resources are stretched fairly thin.
The plans for sale in the individual market are also particularly volatile, with varying insurers in a given market from one year to the next, along with network and benefit changes. This makes it harder (and not generally advantageous) for people to “set it and forget it” when it comes to their individual market health insurance. It’s important and often necessary to shop around each year, and the compressed enrollment window makes it more challenging for everyone in the individual market to be able to do that, particularly if they need assistance with the process.
Opponents of a shorter open enrollment window also note that sick people tend to sign up as soon as possible, early in the enrollment window. But young, healthy people (ie, the “young invincibles”) are more likely to procrastinate and sign up at the last minute. So it’s especially important to communicate to that population that open enrollment ends December 15 so that they don’t wait too long and miss the window altogether.
What If I Have Coverage Through My Employer?
The open enrollment changes and provisions described above apply only in the individual health insurance market, so they don’t affect people who get health insurance coverage from their employers. But if you have employer-sponsored health insurance, your open enrollment period may overlap with the individual market’s open enrollment period.
Many employer-sponsored health plans hold their open enrollment periods in the fall, so that coverage changes can be effective on January 1 of the coming year. That’s not always the case, however—your employer might have a plan that doesn’t follow the calendar year, so your open enrollment might be a different time of the year.
Open enrollment for employer-sponsored plans is often shorter than the enrollment window used in the individual market, but your employer will communicate the key dates that apply to your plan. Your employer may hold meetings for employees to prepare for open enrollment, or they may send personalized information to each employee. If you have questions, now’s the time to ask. If you’re unsure of any of the terminology used to describe the plans, ask for help before you make a decision.
Employees often stick with the same plan from one year to the next simply due to inertia—even when a better option becomes available. If your employer offers more than one plan option, it’s worth your while to carefully consider each plan during open enrollment. Look at how much you’ll pay in premiums (the amount that will be deducted from your paycheck), and how much you’ll pay in out-of-pocket costs when you need medical care. Think about your recent health care spending, and consider any expenses you expect to incur in the coming year. If one of the other plan options will present a better value than the one you have now, open enrollment is your opportunity to switch plans, and your employer likely has a process in place that will make it easy to do so.
If you or any of your family members take prescription drugs or see a particular doctor, make sure you double-check the covered drug lists (formularies) and provider network details for each of the plans your employer offers. If you switch plans and then find out after the new plan takes effect that your medications and/or doctor aren’t covered, you’ll have to wait until the next year’s open enrollment to switch plans again.
What If I Miss Open Enrollment?
After open enrollment ends, your opportunity to enroll in health insurance coverage for 2021 will be limited. You’ll be able to sign up mid-year if you experience a qualifying event (eg, loss of coverage, the birth or adoption of a child, etc.), and in most cases that applies to plans purchased in the exchange or directly from an insurance company. But it’s important to note that some of the qualifying events, including moving to a new area or getting married, only trigger a special enrollment period if you already had minimum essential coverage in place before the qualifying event.
So if you miss the open enrollment period for 2021 coverage and don’t experience a valid qualifying event later in the year, you won’t be able to sign up for an individual market major medical health insurance plan until the next open enrollment period starts again in the fall of 2021 (coverage, in that case, would be effective January 2022).
Medicaid and CHIP enrollment are year-round, however, for those who are eligible. And Native Americans can enroll in health plans through the exchanges year-round as well.
A Word From Verywell
We know that health insurance can be confusing, and the constant debate over health care reform has certainly added to that confusion in recent years. But the overall structure of the individual market will be roughly the same in 2021 as it was in 2020.
There is an ongoing lawsuit (California v. Texas) in an effort to overturn the ACA. Although oral arguments in the case are expected to be heard by the Supreme Court in the fall of 2020, nothing will change about open enrollment for 2021 coverage (the court’s ruling is most likely to be issued in mid-2021).13
Your premium subsidies and cost-sharing reductions will still be available, and with the exception of Pennsylvania (and possibly New Jersey), the exchanges in every state will functioning just the same as they were during the last open enrollment period.
Although the Trump administration cut off funding for cost-sharing reductions in the fall of 2017, the impact of this (higher premiums—particularly for silver plans—in nearly every state) is being mostly borne by the federal government, in the form of larger premium subsidies. The cost-sharing reductions themselves will continue to be available in 2021 to anyone all eligible enrollees.
The individual mandate penalty no longer applies, unless you’re in a state that has its own mandate and penalty (for 2021, this is DC, Massachusetts, New Jersey, Rhode Island, and California). But going without coverage isn’t recommended. If you do go uninsured, you likely won’t have an option to get coverage until 2022, and you’d be left uninsured if a medical emergency were to arise mid-year.
The good news is that rate changes for 2020 are shaping up to be quite small, and insurers are joining the exchanges in some areas. Premium subsidies continue to cover the large majority of the cost of coverage for most exchange enrollees, and bronze or gold plans will continue to be particularly inexpensive in many areas for people who qualify for premium subsidies (since the cost of CSR is generally being added to silver plan rates, and subsidies are based on the cost of a silver plan). Open enrollment will run from November 1 to December 15 in most states, and it’s your opportunity to sign up for a plan and take advantage of those premium subsidies if you’re eligible. So if you know someone who buys their own health insurance, spread the word!