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Do you want to get health insurance, switch to a different plan or make any adjustments to the plan you currently have? If you need to buy insurance from the government-backed Health Insurance Marketplace or want to make any changes to the health insurance you receive through your job, here's what you should know ahead of the open enrollment period.
What Is Open Enrollment?
Open enrollment is an annual period during which you can enroll in health insurance or change your existing health insurance plan. If you get insurance through your job, check with your employer to verify when open enrollment takes place for your plan. It's usually in the fall but may vary from one insurance plan to another.
If you're unemployed or self-employed or your employer doesn't offer health insurance, you can shop for health insurance on the Health Insurance Marketplace at Healthcare.gov or your state's marketplace. Open enrollment for Marketplace health insurance runs from November 1, 2021, to January 15, 2022, for coverage starting January 1, 2022.
Understanding the Health Insurance Marketplace
Under the Affordable Care Act (ACA), health insurance plans sold on the Marketplace must cover preexisting conditions and 10 essential health benefits, including maternity care and prescription drugs. You can also buy dental insurance through the Marketplace.
You can browse plans on Healthcare.gov or your state's Marketplace to get an idea of plan features, prices and subsidies before you apply for insurance. You'll be asked for your ZIP code, how many people you want to insure (as well as their ages and any health conditions, such as pregnancy) and your estimated 2022 income. You'll also answer some general questions about your use of health care, such as how many medications you take and how often you visit the doctor.
Based on this information, you'll be shown plans from the four tiers:
- Bronze plans have the lowest premiums but the highest out-of-pocket costs.
- Silver plans have lower premiums and moderate out-of-pocket costs.
- Gold plans have higher premiums and lower out-of-pocket costs.
- Platinum plans have the highest premiums and the lowest out-of-pocket costs.
You can sort and filter plan results by criteria such as tier, plan type (HMO or PPO), deductible, patient ratings and more. All plans within a tier must offer the same coverage, but the cost of premiums, copays, deductibles, coinsurance and out-of-pocket maximums can vary from plan to plan. Review your budget (or make one) to get an idea of how much you can afford to spend on health insurance. Compare plan costs and think about how you expect your family to use health care to decide which plan will work best for your needs.
Information You Need to Prepare for Open Enrollment
Once you've visited the Marketplace and have an idea of what's available to you, it's time to apply for insurance. Be prepared with the following information:
- Household size: How many people need insurance?
- Personal information: Have the name, address, email address, Social Security number, birth date and citizenship status of each person you plan to enroll. Be prepared to provide proof of citizenship.
- Financial information: You'll need to figure out your modified adjusted gross income (MAGI) to see if you qualify for cost-sharing subsidies or premium subsidies that can reduce your monthly premium. To assist Americans affected by the pandemic, the American Rescue Plan of 2021 increased premium subsidies and eliminated the upper income limits to qualify for subsidies through 2022. That means you may qualify for subsidies this year even if your income puts you above the normal income limits.
Generally, your MAGI is the same as the adjusted gross income (AGI) reported on your federal Form 1040 at tax time, plus any non-taxable Social Security benefits, tax-exempt interest earnings, or foreign earned income and housing expenses for Americans living abroad. You can reduce your MAGI (and potentially qualify for larger subsidies) by contributing to a pretax retirement plan or health savings account (HSA). Be prepared to verify your income with pay stubs, tax returns, W-2 forms and other documentation.
- Coverage information: You'll want to refer to the premium amount and coverage available for any employer-sponsored plan available to your household, even if you aren't participating in that plan. You may want to weigh your options once you learn more about the Marketplace plans available to you.
- Payment method: How do you plan to pay your premiums? Having premiums automatically withdrawn from your bank account or charged to your credit card each month can help ensure you don't miss a payment and lose your coverage.
- Names and ZIP codes of your doctors: You can filter plan results to show only plans that your doctors accept. (Always contact your doctor's office to verify before enrolling in a plan.)
- Medications your household members take and treatments they require: You'll need to make sure the insurance plan covers them.
Navigating your options can be confusing and any errors during the application process could delay your enrollment. Make it easier on yourself by getting help from a certified application counselor (CAC), health insurance Navigator, or insurance agent or broker certified by the Marketplace. Each has a slightly different role: A CAC helps you enroll in coverage, whereas a Navigator helps you enroll but can also explain the plans and subsidies. An agent or broker can do all the above but can also recommend specific plans, give advice based on your situation, and help you resolve problems during the application process and after you've enrolled.
Is Open Enrollment the Only Time You Can Buy Insurance?
The open enrollment period isn't necessarily your only window for buying Marketplace health insurance. Certain life events, including having a baby or adopting a child, getting married, involuntarily losing your health insurance or moving, may qualify you for a Special Enrollment Period. Depending on your situation, you'll have either 60 days before or 60 days after the event to apply. Native Americans can buy Marketplace insurance year-round.
Health insurance policies through employers also typically allow for insurance enrollment outside the open enrollment period in the case of a qualifying life event. The length of this enrollment period, as well as what's considered a life event, can vary by employer. Some employers may provide employees as little as 30 days to submit necessary paperwork that proves the life event and to select their new or updated health insurance policy.
Other Ways to Get Health Insurance
If you don't think the Marketplace will work for you and you need health insurance, there are other options that don't require waiting for open enrollment.
- COBRA: Employees who lose their employer-provided health insurance coverage are generally eligible for COBRA continuation coverage, which allows you to keep your existing insurance for up to 36 months. However, you'll usually have to pay your full insurance premium, plus administrative costs, so compare Marketplace insurance to see if it costs less.
- Medicaid: This federal program provides health insurance for those with low incomes. (It may be called something different in your state.) When you apply for insurance on the Marketplace, you'll be notified if you qualify for Medicaid. When you apply for insurance on the Marketplace, you'll be notified if you qualify.
- Children's Health Insurance Program (CHIP): CHIP covers children aged 19 and under whose household incomes are too high to qualify them for Medicaid. You can apply through the Marketplace or your state agency.
- Short-term health insurance: Short-term insurance can fill gaps when you're between jobs or waiting for your Marketplace plan to kick in. Coverage through short-term insurance plans is generally affordable and takes effect immediately. These private insurance plans have lots of limitations and exclusions, however, so review the details carefully before buying one.
Protect Your Health and Your Bank Account
Health insurance may seem costly, but going without it can be even more expensive if a serious illness or accident strikes and leaves you with mountains of medical debt to pay. In 2022, the Health Insurance Marketplace will offer financial assistance to people at a wide range of income levels. If you don't have employer-based insurance, now is a great time to check out what the Marketplace has to offer and how it can protect your health and your finances.