COVID-19 Special Enrollment and the Affordable Care Act: What this means for you and your Health Insurance

By Garrett Smith, April 13, 2021

Although the “COVID-19 Special Enrollment” was announced mid-January, I realize many of you still have questions on this program. What does this mean? Should I even care? And given the news that President Biden has extended the enrollment period through the end on August 15 there's still time to get answers.

If you don’t understand what the “Affordable Care Act” (ACA) is or how it has changed, please read the “Background Info” section. If you already understand the basics and how we got here you can skip the background section and get right to “The Point.”

BACKGROUND INFO

The Affordable Care Act was signed into law on March 23, 2010 by then President Barack Obama (dubbed “Obamacare” by the media). This new program created a country-wide, government marketplace for consumers to purchase their healthcare. It also stated that health insurance companies CANNOT deny consumers coverage based on pre-existing conditions and that all policies available on the marketplace had to include all “essential health benefits”.

It made healthcare coverage mandatory for everyone and imposed a tax penalty for not having coverage. In 2017, past President Donald Trump passed the “Tax Cuts and Jobs Act of 2017” which effectively removed the tax penalty starting in 2019. Now how did that affect us? Simply put, the tax penalty was essential to keep the affordable care act, for lack of better term, affordable. If you’ve shopped on the marketplace (found on https://www.healthcare.gov), I’m sure you’ve seen the prices are currently EXTREMELY high. The reality is that the current prices reflect the true cost of insurance when everyone does not participate. By continuing to force the health insurance companies to pay for everyone with pre-existing conditions, and offering no penalty or incentive to force healthy consumers to purchase insurance, the average consumer is now stuck with policies that have risen in cost dramatically.

THE POINT

Extended Availability - The traditional enrollment period for an ACA policy is November 1st to December 15th, with policies going into effect January 1st of the next year. However, with the special enrollment period thanks to COVID-19, you now have the opportunity to get an ACA policy until August 15th of 2021. Depending on the month you enroll, your policy goes into effect the 1st day of the following month (example - enroll on March 15th, your policy starts on April 1st).

Eligibility - So let’s answer the question: should I care? Absolutely! If you can enroll into an ACA policy, I highly recommend it as these policies are designed to cover EVERYTHING. Make sure you read the fine print and understand your deductibles and which networks your specific plan is accepted in.

Now what about those rising costs we talked about in the background section? Thanks for reminding me, There are two prime candidates for an ACA policy (per my humble opinion):

If you qualify for a tax credit

If you have pre-existing conditions

Affordability - The tax credit qualification is based on your current income. Discounts are based on the federal poverty level. If your income is between 100% to 400% of the federal poverty level, you qualify for a tax credit on an ACA policy. This can DRASTICALLY reduce the rate on these policies and turn an otherwise unaffordable policy into an affordable one. Not sure where you fall on the Federal Poverty Level? You can check out the official federal poverty levels here.

Filling in the gaps - It is important to note that most ACA policies have EXTREMELY high deductibles and out of pocket maximums. This can leave you in a difficult place when illness or accidents come calling, but you can fill this gap by looking outside of the marketplace. In the private market there are many affordable options available to help supplement an ACA policy. It's even possible to create a package that will cover almost all of your deductibles or out of pocket maximums.

This is where I can help. If you have an ACA plan and you’re looking to reduce or eliminate your deductibles or you just want to cover those high out of pocket maximums, fill out the contact form on this site and I’ll be glad to show you all your options within 24 hours.