If you need health insurance, and can’t get it from your job, this is the time for you. It’s the season when anyone who wants a 2021 Obamacare health plan can shop for one.
The waves of job losses caused by the pandemic have disrupted many people’s incomes and insurance arrangements. But even people whose work life is unchanged can still consider their 2021 options now if they will need coverage.
If your income is low, you may qualify for Medicaid insurance with no premium at all.
In the 36 states (and the District of Columbia) with expanded Medicaid, you can qualify for free coverage based on your monthly income. The income threshold is around $1,400 for a single person or $2,950 for a family of four. Many Americans who have recently lost jobs because of the coronavirus pandemic may qualify. This is true in Idaho, Utah and Nebraska for the first time this year.
If you have a low income and don’t live in one of the highlighted states, it’s still worth checking with your state’s Medicaid agency. Some states — like Wisconsin — offer coverage to many low-income families. And other states offer Medicaid or Children’s Health Insurance Plan coverage to children or parents of young children with low incomes.
If you don’t qualify for Medicaid, consider an A.C.A. marketplace plan.
The Affordable Care Act set up marketplaces for private health plans in every part of the country. The options vary depending on where you live, but there are more choices in many markets for 2021 than in previous years, and average prices are down slightly. The federal website healthcare.gov is a good first stop to look for options in your area. Eleven states and the District of Columbia run their own marketplaces; links from the federal site will direct you there. You can also use a private company that’s been certified by the government to help you pick a plan; it is listed here.
In most states, the open enrollment period lasts only through Dec. 15, so it’s important to shop now. If you miss the deadline, you may be unable to qualify for new coverage unless you have a major change in your life, like job loss or a divorce.
Plans that are compliant with the Affordable Care Act are available for anyone under 65, regardless of health history. Under the law, prices are allowed to vary only depending on age, location and whether you smoke.
Plans are organized via four “metal” tiers. In general, bronze plans tend to have the highest deductibles and platinum plans the lowest. In picking a plan, you should consider both the premium and how much you would have to pay in cost sharing if you became ill. Plans also differ according to which doctors, hospitals and drugs they include. In some cases, plans may offer special extra benefits, like free access to telemedicine. Depending on your needs, you may want to research those details in addition to considering the dollars involved.
Consider all of the choices carefully. Because of a quirk of policy, in some parts of the country more generous gold plans may turn out to be cheaper than less generous silver ones.
Most people without insurance will qualify for subsidies.
The sticker price for insurance can be high in many markets, but if you earn less than 400 percent of the federal poverty level — or around $51,000 a year for a single person or $105,000 for a family of four — you can quality for subsidies that limit your premium for certain plans to a set fraction of your income. Make sure you enter your income as you shop so you can see the prices that are relevant to you. Surveys show that some uninsured people don’t buy coverage because they assume they can’t afford the sticker price. This is why looking up your price with subsidies is important.
For people with incomes below around $31,000 for a single person or $65,500 for a family of four, subsidies will also lower your deductibles and co-payments if you buy a plan in the silver category.
If you don’t qualify for subsidies, there may be additional choices.
Many shoppers who earn too much to qualify for help paying their premiums may be better off with health plans sold directly by insurance companies. Those plans will not be listed on healthcare.gov. A broker or an online brokerage can help you find additional options. You may also be able to find offerings by contacting insurance companies directly or visiting their websites. Finding such plans will take more work, but may yield a better deal.
But be careful: Once you’re shopping outside of healthcare.gov, not all the plans will be held to the same standards, and there are sketchy options out there that don’t offer comprehensive coverage. Plans that adhere to all the Affordable Care Act rules, which include a standard set of benefits, and are sold to people regardless of prior illness, are called “qualified health plans.”
There are also “short-term” plans. These tend to be cheaper but can have more benefit holes, and they may not be offered to everyone. Some organizations known as health sharing ministries offer products that sound like health insurance but are actually religious fund pooling groups that lack the same kind of guarantees on paying for your care if you become ill. Avoid companies that cold-call your phone offering health insurance; they’re often scams.
You can get free help picking the right plan.
Choosing an insurance plan is hard. Health insurance is a complicated product, with its mix of premiums, deductibles, co-payments and provider networks. For a basic and slightly whimsical approach to considering plan options, please consult this cartoon flow chart.
But free professional advice is also available. Navigators who work for nonprofit groups and professional brokers, who earn a commission by selling health plans, can help you understand your options and the process of signing up. You can look up contact information for helpers in your area here.