The annual open enrollment period for Affordable Care Act health insurance plans starts today and runs through December 15th. That means you’ve only got about six weeks to find comprehensive health insurance for 2021.
With so little time to sort through your options and find the right coverage, it’s a good idea to gather up what you need beforehand.
Armed with the right info and documents ahead of time, it’ll take you less time to sign up. Here’s what you’ll need to have on hand when you start shopping for marketplace coverage this year.
Personal info
To apply for health insurance coverage, you’ll need to know personal details for yourself and the other people on your application. This includes:
- Demographic information about all applicants, such as age and sex
- Where everyone who’s applying for coverage lives (the physical address)
- Social security numbers for everyone applying
- Legal status documents (for legal immigrants)
When you fill out the application, you’ll need to list everyone who’s going to be covered under the plan, along with their details, like age and sex. This includes adult children (up to age 26) who may not live with you.
Unmarried partners living in the same household should apply for coverage separately unless they have children together or one is a dependent of the other.
In addition to names and relationships, you’ll need to know everyone’s address. If they live in the same household as you, that’s easy. But if some people live elsewhere, gathering addresses might take a little more work. In addition to having the address of your home, you’ll also need your mailing address if it’s different.
The next step, gathering Social Security numbers for every person on your application, may take a little more digging. If you don’t have the numbers, you can bypass that portion of the application when you start. But it will require more documentation from you down the road, so try to get it if you can.
Lawfully present immigrants need to enter additional information when applying for coverage. If anyone in your group falls into that category, keep the immigration documents close at hand so you can refer to them during the process.
Household income
All sources of household income need to be disclosed on your application — not just the main breadwinner’s paycheck. That includes your teenagers’ part-time jobs, your alimony checks, your Social Security payments and the money that you get from your rental property.
To find specific information about what qualifies as income for ACA purposes, check out HealthCare.gov’s income page.
Keep in mind that the application will ask for next year’s income, not what you’ve earned this year.
You may not know exactly how much you’re going to make in the upcoming year, so just provide your best estimate. Looking at paystubs or W-2s from the past year may help.
If your income changes mid-year, make sure you update your application.
Reporting an increase can spare you from having to pay back extra premium credits at tax time. On the other hand, reporting a drop in income might qualify you for extra premium assistance right away.
Current insurance info (if you have any)
If you or someone in your household already has health insurance, then grab the documents or pull them up from the web so you can see what’s already there. There are two good reasons for this:
- To double-check the coverage. If it’s been a while since you looked at your old health plan (or you’ve never actually read the fine print), take some time to check the coverage. You might be surprised to find exclusions or coverage limits you didn’t know about. If your health needs have changed (or are changing for 2021), then you’ll need a new plan that covers what you need.
- Comparison shopping. You won’t know if something’s a good deal unless you compare it to what you’ve got. If you don’t have health insurance, a new plan is obviously better than nothing. But if you have an existing health plan, you’ll want to make sure any low prices and seemingly good deals are actually a good deal for you.
And before you shop, know what you’re buying (and what you need).
There will be lots of different plans to choose from — depending on where you live — each with its own slate of benefits and monthly premium costs.
Having a clear idea of what you want from a health policy will help you narrow down your choices.
Metal tiers
Marketplace plans are structured by a tier system, with four metal tiers and one tier called “catastrophic coverage.” This is true whether you actually buy a plan from a government site or a private marketplace (like ours).
Catastrophic coverage is reserved for young adults and people who qualify based on a specific set of guidelines. The other tiers are ranked by metal:
- Bronze. As the lowest tiered option, bronze plans will cover about 60% of your medical costs, on average. These plans come with low premiums and higher cost sharing (deductibles and other costs).
- Silver. The government uses the second-lowest cost silver plan to set premium subsidies, so silver plans are considered the “benchmark” plan in that sense. They cover about 70% of your medical costs, on average. It’s a mid-tier option that’s also the most popular tier on the marketplace.
- Gold. These plans cost more per month than bronze or silver plans, but you’ll typically pay less out of pocket for medical care. Gold plans cover about 80% of your medical costs, on average.
- Platinum. There are very few platinum plans on the marketplace. These plans cover about 90% of your medical costs and come with high premiums (but low cost sharing, like deductibles).
You’ll need to decide which end of the spectrum works better for you.
If you need a lot of medical care in a year, it may be better to go with a plan where you’ll meet the deductible quickly so that you have lower costs for the rest of the year. But if you only see your doctor a couple times a year, paying a lot in premiums may not make sense for you.
Cost savings
Marketplace plans also qualify for premium savings in the form of advance premium tax credits (or “subsidies”). These lower your monthly premium costs. If you earn between 100% and 400% of the federal poverty line — calculated automatically when you apply — you can get help with your premiums.
Plus, people earning between 100% and 250% of the poverty level get extra help with cost sharing, meaning lower deductibles, coinsurance and/or copays for silver level plans.
(And just as a reminder, you can get subsidies on marketplace plans even if you don’t use the government sites to sign up. Our private marketplace can help you save, too.)
You may also qualify to enroll in a health savings account (HSA), which allows you to set aside pre-tax dollars for medical expenses. Study up on HSA rules and benefits before you settle on a health insurance plan, though.
For one thing, HSAs are only compatible with high deductible health plans (HDHP), which have lower monthly premiums but require significant contributions from you before they’ll start paying their share of the bills.
Current providers & meds
If you’re a big fan of your current doctor, then make sure any plan you switch to covers that provider. That’s true of everyone applying for coverage.
Gather a list of your preferred providers so you can check a plan’s details and make sure your doctors are in-network. There’s no point in getting a health plan that doesn’t cover the providers you like or need.
And while you’re at it, jot down any providers you’re likely to need in the coming year, if you know about any.
If you’re expecting a baby in 2021, for instance, make sure the health plan you pick has good maternity coverage and a healthy list of OBGYNs to pick from.
Maternity coverage is an essential health benefit under the Affordable Care Act, which means all marketplace plans cover it. But your cost sharing for these services will still vary widely based on the plan you get.
That’s why it’s so important to shop carefully for what you need.
The same goes for prescriptions. If you (and anyone else in your household) take regular medications, write those down, too. You’ll need to make sure your new plan covers those drugs as well.
Dental care
The ACA requires health plans to cover pediatric dental, so if you have kids, your family health plan will cover their dental care. But there’s no requirement for adult coverage, and your health plan likely won’t cover dental care for you.
If the plan you choose doesn’t cover dental care, you may have the option to add a separate dental plan before finalizing your health insurance choice. Just note that you’ll pay an extra monthly premium for that coverage.
As with medical insurance, check whether your current dentist is in-network before you settle on a plan. Have your dentist’s name and location on hand so you can make sure.
And as with any kind of coverage, shop carefully.
You might find a great deal on medical coverage with a marketplace plan from one insurer. But that doesn’t necessarily mean the same insurer offers the best dental plan for you. Look around before committing to an ancillary benefit like dental or vision coverage.
Info & docs ready? Get shopping.
Open enrollment for marketplace coverage — that’s full, comprehensive coverage that adheres to all the rules of the Affordable Care Act — runs from November 1st through December 15th in just about every state. With not much time to make a decision, now’s the time to make sure you’ve got the right plan in place for 2021.
Gather your documents, make mental notes of what you need and get shopping. The sooner you start, the sooner you can choose a plan that fits your needs and budget.
