Everything you need to know to enroll in an affordable health insurance plan during the 2021 open enrollment period.

Open enrollment for 2021 individual-market health plans has started. Whether you’re new to the individual market or have been buying your own health insurance for years, you likely have questions.

This guide is designed to answer those questions and give you a solid understanding of what you need to know about open enrollment and the process of buying health coverage for the coming year.

When does open enrollment begin?

In Maine and New Hampshire, open enrollment for Marketplace 2021 health coverage for individuals and families started on November 1, 2020 and it will end on December 15, 2020.

Can I get a subsidy to help cover the cost of my health plan?

Premium subsidies (aka premium tax credits) are available in both Maine and New Hampshire, if you shop on the marketplace, to help bring the cost for your health insurance down. Eligibility is based on your household income. 

Here’s a detailed overview of how premium subsidies work.

For 2021 health coverage, subsidy eligibility extends to an income of $51,040 for a single person, and $104,800 for a family of four. 

It’s referred to as MAGI (Modified Adjusted Gross Income), but it’s not the same as the general MAGI calculations you may be familiar with in other circumstances. If your income is a little too high to qualify for subsidies, there are steps you may be able to take to get it into the subsidy-eligible range.

MAGI is adjusted gross income (AGI) plus these, if any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest.

• For many people, MAGI is identical or very close to adjusted gross income. (AGI can be found on line 8b of your 2019 IRS Form 1040.)
• MAGI doesn’t include Supplemental Security Income (SSI).
• MAGI does not appear as a line on your tax return.

Here is the information you will need to enroll in health insurance for 2021?

You can enroll for a health insurance plan online, over the phone, or in-person. Regardless of the method, if you’re enrolling in a plan through the Marketplace, you’re going to need to have the following information on hand for each person signing up:

• Name
• Address
• Social Security Numbers
• Dates of birth
• and your projected MAGI for next year

When will the health insurance plan take effect?

In almost all cases, your coverage is going to take effect January 1, 2021 if you sign up before December 15, 2020. If you’re already enrolled in an individual-market plan and you’re picking a different plan during open enrollment, your current plan will end on December 31 and your new plan will take effect seamlessly on January 1 (assuming you continue to pay all of your premiums when they’re due).

If you’re enrolling during the open enrollment period but you also have a qualifying event, you may be able to get coverage before the start of 2021. For example, if you get married and apply for coverage in November, you can have a December 1 start date if you use your special enrollment period, whereas you’ll have a January 1 effective date if you just enroll under the normal open enrollment period rules.

So if your special enrollment period overlaps with open enrollment, you might want to utilize your special enrollment period in order to get an effective date before January 1.

What happens if you don’t enroll in a plan during open enrollment?

If you don’t enroll in an ACA-compliant health insurance plan by the end of open enrollment, your buying options will likely be very limited for the coming year. Open enrollment won’t come around again until November 2021, with coverage effective the first of the following year.

But depending on the circumstances, you might still be able to get coverage after open enrollment ends:

Medicaid enrollment is year-round.

Medicaid and CHIP enrollment are available year-round for those who qualify. If your income drops to a Medicaid-eligible level later in the year, you’ll be able to enroll at that point.

Similarly, if you’re on Medicaid and your income increases to a level that makes you ineligible for Medicaid, you’ll have an opportunity to switch to a private plan at that point, with the loss of your Medicaid plan serving as the qualifying event that triggers a special enrollment period.

Native Americans can enroll year-round

Native Americans can enroll in plans through the exchange year-round. 

Special enrollment period if you have a qualifying event

If you have a qualifying event during the year, you’ll have access to a special enrollment period (SEP). Qualifying events include marriage (assuming at least one spouse already had coverage prior to the marriage), the birth or adoption of a child, loss of other minimum essential coverage, or a permanent move to a new geographical area where the available health plans are different from what was available in your prior location (again, assuming you already had coverage prior to your move).

Is there a penalty for not having insurance?

Essentially no. President Trump tried to eliminate the penalty shortly after he was elected but was not allowed. Therefore he instructed Congress to pass a law that lowered Obamacare’s original federal individual mandate penalty to $0 at the start of 2019. This means if you do not have insurance you are still charged the penalty but it’s $0.

People who are uninsured will still be subjected to this penalty but it’s $0 so it no longer has any real effect. However, if you do not live in Maine or New Hampshire you may still have to pay.

Democrats have fought to keep the penalty in place and in four states and the District of Columbia have imposed additional tax penalties for not having health insurance:

• Massachusetts
• New Jersey
• California
• Rhode Island
• District of Columbia

Are you ready to sign up?

Here are the steps to take:

1. Get a quote here at MaineInsuranceOptions.com 
2. Consult with a trained advisor. If you have questions, set up an appointment with an agent or broker in your area who will be able to help you sort through the available options and figure out which one will best meet your needs. (Click here to get help.)

Should I just let my existing plan renew for 2021?

If you’re already enrolled in a Marketplace health insurance plan through the marketplace, can you just let that plan automatically renew for 2021? In most cases, yes, assuming your plan will still be available next year.

You should have received a letter in the mail with details about your plans changes for next year along with your new premium cost.

If you are getting a subsidy (or tax credit) that lowers your premium, you should update your application with your income to make sure the subsidy stays in place.

But relying on auto-renewal is not in your best interest. No matter how much you like your current plan, it pays to shop around during open enrollment and see if a plan change is worth your while.

Here’s why:

You won’t be able to pick a new plan after your coverage is auto-renewed.

The auto-renewal process happens right after December 15, for people who haven’t manually renewed or selected a new plan. That’s after the end of open enrollment, which means you won’t get a chance to change your mind if it turns out that your plan’s after-subsidy premiums are increasing or the provider network is changing.

Your subsidy amount will generally change from one year to the next.

If your subsidy gets smaller, auto-renewal could result in higher premiums next year. As has been the case for the last couple of years, there are a plethora of new insurers entering insurance markets all across the country for 2021. This is good news in terms of competition and plan options. But if those plans are priced below the existing options, they can bring down the cost of the benchmark plan and reduce premium subsidies for everyone in the area. In Maine average benchmark premiums are about 2 percent lower for 2021 than they were for 2020. Shopping around for a different plan — as opposed to letting your plan auto-renew – might result in substantial savings.

If you receive a subsidy, auto-renewal could be dicey even if the subsidy amount isn’t declining.

If you rely on auto-renewal (as opposed to manually renewing and completing the financial eligibility determination process for 2021), the exchange can renew your plan without a premium subsidy in certain circumstances. This includes situations in which the most recent tax return on file shows that your income was over 500% of the poverty level or below 100% of the poverty level. It also includes situations in which you didn’t give the exchange permission to access your financial information in subsequent years, resulting a loss of your subsidy altogether.

Who can help me enroll in a health insurance plan for 2021?

Health insurance is complicated, and many people want or need personal assistance with the application process and with ongoing insurance utilization questions. To fill this need, there are a variety of agents and brokers statewide who are trained to guide people through the process of researching and enrolling in health plans, and some can provide ongoing support after the plan is purchased.

Insurance brokers and agents

Insurance brokers and agents who are certified by the exchanges can also explain plan details and help consumers determine subsidy or MaineCare eligibility, but – and this is a key difference – they can also make plan recommendations based on a client’s particular situation.

Agents and brokers continue to assist their clients after the plan is purchased, helping them sort out questions and problems regarding billing, utilization, claims, and appeals. Brokers and agents also generally carry errors and omissions insurance, and are licensed by their state department of insurance (this is in addition to their certification with the exchange; Navigators and CACs are trained and certified by the exchange, but are not licensed by the state insurance department).

For health insurance purposes, independent agents and brokers are virtually the same thing, although brokers may represent more carriers or offer different types of insurance products.