It鈥檚 Open Enrollment. Here鈥檚 What You Need to Know
California鈥檚 annual health insurance enrollment season for individuals and families kicks off this week against a dramatic backdrop: the hotly contested presidential election; a pandemic raging out of control in much of the U.S.; and, on Nov. 10, a Supreme Court hearing of a case that could end the Affordable Care Act and strand millions without coverage.
The massive unemployment caused by the pandemic has already stripped employer-based health insurance from nationwide and induced severe financial anxiety as families struggle to pay rent and buy food.
One question hovering over enrollment for 2021 health plans is whether the large-scale loss of medical coverage will generate a surge of sign-ups, or if more pressing financial worries for many people will push insurance lower down their priority list.
鈥淧eople have so many things to deal with: They鈥檝e lost jobs, they鈥檝e lost a lot of income, and in California they鈥檙e also facing fires. I don鈥檛 think health insurance has been top of mind for people,鈥 says Cheryl Fish-Parcham, director of access initiatives at Families USA, a consumer health care advocacy organization.
But Peter Lee, executive director of Covered California, the state鈥檚 ACA marketplace, is confident it will match the 40% increase in new sign-ups it had for 2020 coverage.
鈥淚t is clear that COVID is on Californians鈥 minds,鈥 he says. 鈥淵ou cannot have COVID on your mind without also having coverage on your mind.鈥
A Supreme Court decision on the future of the ACA probably won鈥檛 come until well into next year, and it is unlikely to affect your 2021 coverage. 鈥淪o people should feel confident in looking for a health plan,鈥 says Sara Collins, vice president for health care coverage and access at the Commonwealth Fund.
If you are 65 or older, you probably qualify for Medicare, the federal program for seniors, which is entirely separate from the ACA exchanges and broader individual market. Advantage plans and Part D drug plans is also underway and ends Dec. 7. Insurance agents can usually help you with Medicare, and you can get advice by calling 1-800-434-0222.
If you are under 65, live in the Golden State and want to buy insurance for you and your family, start with Covered California. It鈥檚 the only place you can get federal and state assistance to cover some or all of your premiums.
The enrollment period for Covered California, and for the individual market outside the exchange, started Nov. 1 and runs through Jan. 31. In states whose exchanges are operated by the federal government, the enrollment .
If you lost coverage and need it for the month of December this year, you can still get it through Covered California if you sign up by Nov. 30. For regular annual coverage that starts Jan. 1, you must sign up by Dec. 15. If you miss that deadline, you can still get coverage starting Feb. 1 if you enroll by the final Jan. 31 deadline.
Many people leave money on the table because they aren鈥檛 aware of the financial assistance or think they earn too much to qualify. But you don鈥檛 need to be poor to get aid.
The federal subsidies, which are tax credits typically provided in the form of reduced monthly premiums, are available to individuals with annual income up to about $51,000 and a family of four with income up to nearly $105,000.
California has supplemented the federal aid with state-funded assistance that extends further into the middle class: up to around $76,500 for an individual and $157,000 for a family of four.
If you log on to Covered California鈥檚 website, , you can check how much financial help you qualify for and compare health plans. Or, an insurance agent or certified enroller can do the legwork work for you 鈥 at no charge. You can find one on the website. You can also call Covered California directly at 800-300-1506.
If your income is below 138% of the federal poverty level, you will probably , the government insurance program for people of limited means. The Covered California website 鈥 or an enroller 鈥 will let you know if you do and walk you through signing up. You can also Medi-Cal office. If you don鈥檛 qualify for Medi-Cal, your children might, because the income threshold is higher for them.
If you are looking for exchange-sponsored coverage, click the 鈥渟hop and compare鈥 tab on the Covered California website, which takes you to a screen that asks your age, income, ZIP code and family size and shows the health plans available, their premiums and your aid amount.
The website also provides of the participating health plans. And you can check for plans that have your doctors in their networks 鈥 though, as the website warns, that information is not always up to date.
Comparison shopping on the website is straightforward, because at each of the four levels of coverage 鈥 bronze, silver, gold and platinum 鈥 benefits are uniform from insurer to insurer. So once you鈥檝e decided which metal tier is best for you, you only need to think about the price and whether your providers are in the network.
If you have a Covered California health plan already, shop around rather than automatically renew the one you鈥檙e in. 鈥淭he best deal last year is not necessarily the best deal this year,鈥 says Anthony Wright, executive director of Health Access California.
Covered California announced a last month, but actual rate changes vary across the state and among carriers.
Anthem Blue Cross, for example, will hike rates by a statewide average of 6%, and the Oscar Health Plan of California by 7.6%, while Blue Shield of California will cut rates by an average of 2.4% and the L.A. Care Health Plan by 4.6%.
If you switch to the lowest-cost plan in your current metal tier, you could reduce your premium by as much as 7.4%, according to Covered California.
Keep in mind that the lowest premium, a bronze plan, is not necessarily the wisest 鈥 or cheapest 鈥 choice.
Tom Freker, a Huntington Beach insurance agent, counsels people not to buy bronze, because its rates could cost more than a higher-premium plan if you fall ill or have a serious accident.
Freker recommends you enroll in Covered California rather than the off-exchange market, even if you don鈥檛 initially qualify for aid. That鈥檚 because if your income drops and you report it to the exchange, you might then qualify and get a break on premiums for the rest of the year or a tax credit the following April, he says.
If your income rises during the year you also should report it, so your monthly premium subsidy is reduced, helping you avoid a potentially hefty tax bill come April.
Your initial aid amount, if you qualify, will be based on your projected 2021 income. In this period of pandemic-driven furloughs, slashed hours and job loss, that might be difficult to predict.
Maria Weston, a massage therapist in Long Beach, said her income has fluctuated week to week since the pandemic started and is down about 50% overall.
Her priority for 2021 was to find a less expensive option, so she switched to a cheaper silver plan last month (current enrollees were allowed to make their health plan choices starting Oct. 1).
Weston鈥檚 new health plan will save her nearly $1,700 a year on premiums. 鈥淚 could put that in my retirement account 鈥 or eat,鈥 she says. 鈥淥ne of the two.鈥
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