Open enrollment for Obamacare closed on December 15th, 2020, but if you weren’t able to sign up, there’s good news. President Biden has been committed to making sure more individuals have access to affordable health care in lieu of the coronavirus pandemic and will be reopening the free healthcare marketplace today, February 15th for an extended three-month period of time.
This means you can sign up for a healthcare plan even if you thought it was too late. In fact, you might even qualify for a free or low premium plan. In this guide, I’ll walk you through everything you need to know about this special enrollment period and how to find out what you could save on health insurance.
Why is Obamacare reopening?
Right now, it’s estimated that there are millions of individuals across the country who currently do not have health insurance. This is particularly troubling since the coronavirus is still not contained and can cause a variety of serious health ailments.
In addition, millions of Americans are unemployed, are working reduced hours, or have taken pay cuts as a result of the economic toll of this pandemic. That’s left many without insurance they once received as a job benefit or unable to pay for a plan out of pocket.
On January 28th, President Biden issued a bundle of executive orders concerning health care. Part of this executive order contained a requirement to reopen the HealthCare.gov website so individuals would have more time to find a health insurance plan. The health insurance marketplace will be open from February 15th until May 15th, 2021.
While signing the order, President Biden stated, “As we continue to battle COVID-19, it’s even more critical that Americans have meaningful access to healthcare.”
This will allow anyone who recently lost insurance, those on expensive COBRA (Consolidated Omnibus Budget Reconciliation Act) plans, and individuals who are uninsured to apply for health care coverage.
How much does Obamacare cost?
If you’re worried about the steep price of health insurance, you might be tempted to let this next open enrollment period come and go. But, many low-income individuals and families can qualify for free health insurance or a reduced premium. If you recently lost your job, you might find you’ll be paying less for an Obamacare plan than your former health insurance plan.
Let’s look at how costs are calculated and some examples based on the national average.
Health insurance pricing factors
There are several factors that are examined when setting a price for your health insurance premium through the open marketplace. Here are a few to keep in mind:
- Location - prices vary across the country to keep in line with the cost of living and average job salaries.
- Annual income - how much money you make per year will significantly affect your health insurance premium.
- Age - how old you are will also impact whether or not you’re eligible for a discounted plan.
- Household size - whether or not you’re applying for yourself, yourself and a spouse, your children, or an entire household will play a large role in determining the cost of your premium. Their ages will also impact your pricing.
- Smoking habits - if you or anyone on your plan smokes, you’ll end up paying a higher premium.
- Spouse’s coverage availability - if your spouse is able to enroll in a healthcare plan through their job, you may pay more for a free marketplace plan.
To give you a better sense of how much you might be able to save by enrolling in a marketplace plan, I’ll run you through three scenarios using U.S. average figures. Keep in mind, your rates will change depending on your zip code.
Scenario 1 - Individual making $50,000 per year
In this scenario, let’s assume you’re 35 years old, the only member of your household, you make $50,000 per year, do not have a spouse or kids, and do not smoke. You’ll likely be eligible for around $21 in financial assistance per month.
For a silver plan (this is the middle-level plan), you would pay around $410 per month/$4,915 per year. This would be approximately 9.83% of your total household salary. Without financial assistance, you would pay $431 per month for a silver-level plan.
Scenario 2 - Single parent with two kids making $40,000 per year
In this scenario, let’s assume you’re a single parent (age 30) with two children living full-time in your household (ages 3 and 6). You’re a nonsmoker and you make $40,000 per year. Based on the U.S. average, you would be eligible for $748 in financial assistance per month. This assistance would cover 80% of your healthcare premium costs.
For a silver plan, you would pay approximately $192 per month/$2,308 per year for healthcare for your entire household. Without financial assistance, your healthcare would cost $940 per month.
Scenario 3 - Couple with two kids making $75,000 per year
In this scenario, let’s assume you and your spouse (ages 32 and 37, respectfully) have three children (ages 7, 9, and 14). You’re all nonsmokers and collectively your household income is $75,000 per year. You could be eligible for as much as $1,155 in financial assistance per month. Your assistance would cover 69% of your healthcare premium costs.
For a silver plan, you would pay approximately $508 monthly/$6,098 per year for coverage for yourself, your spouse, and your three kids. Without this financial assistance, your healthcare would cost $1,663 per month/$19,962 per year.
Who is eligible for financial assistance through the marketplace?
Even if you aren’t sure if you can afford an open marketplace health insurance plan, it never hurts to look and assess your options. You might find you’re able to save money by switching or finally afford coverage thanks to financial assistance plans.
Those who make less than 400% of the federal poverty level are likely to receive some amount of financial assistance through the marketplace. If you are a low-income earner, single parent, or low- to mid-income family with multiple children or dependents, it’s likely that you’re eligible for some form of assistance.
Lastly, even if you do not qualify for financial assistance through the marketplace, but you pay a steep price currently for private insurance through your employer, you might find you’re able to save money by selecting your own plan instead.
Considerations when covering children under Obamacare
Keep in mind, if your children are eligible for CHIP (Children’s Health Insurance Program) or Medicaid, they cannot receive aid through the marketplace, but will likely be able to obtain free or low-priced insurance through one of these programs.
States with Medicaid access often have their own coverage options in addition to federal standards, so you and your family might qualify for coverage even if you don’t meet federal guidelines.
Don’t worry if you aren’t sure if your children qualify for either of these programs. You can find out on the healthcare.gov website.
How to search for plans on the open marketplace
Here are the steps you’ll take to begin looking for marketplace healthcare options.
Step 1: Create an account on the healthcare.gov website
To get started, visit www.healthcare.gov
and click on “Get Coverage.” From here, you’ll be prompted to enter the state you reside in. Once you do, a green “Apply Now” button will appear. Click on this to continue.
From here, you’ll be prompted to create an account or login into your existing one. If you don’t have an account, it may ask for your state of residence again. Once you enter it, an application form will appear below:
Once you finish filling out this information, click “Create Account.”
Step 2: Fill out your application
From there, you’ll be prompted to fill out an application. The application will ask you questions like whether you’re single or married, if you have kids or dependents, and how much money you make per year. Then, it will ask if you want to see if you qualify for financial assistance.
Note: If you make over the threshold listed on your page, it will automatically highlight “no” if you’re not eligible to receive financial assistance.
When you’re done, hit “Continue.” Depending on your answers and the state you live in, you might be prompted to answer a few more questions. Once complete, you’ll be asked to verify your identity, date of birth, and address in order to complete your application.
During the process, you’ll also be prompted to enter a language preference.
Step 3: Review health care options
Once your application is complete and approved (which should be immediate during the open enrollment period), you’ll be able to browse different health care plan options. You can select between Bronze, Silver, Gold, and Platinum coverage options. You can also search for certain providers, look for prescription or copay, review deductibles and out-of-pocket costs when comparing insurance options.
Be sure to review the details of each plan before selecting one — it’s not always best to go with the cheapest. One that costs a little more a month might save you hundreds in copays and prescription filling services.
What do open marketplace insurance plans cover?
You might be wondering how plans in the open marketplace stack up to employer plans. While every plan will have its own benefits and perks, in general, there are 10 essential medical care benefits that all Obamacare health insurance plans offer:
- Emergency services - this includes examinations in hospital emergency rooms (urgent care visits are generally excluded from this offering).
- Ambulatory services - to and from hospitals and other outpatient facilities.
- Hospitalizations - procedures, surgeries, and overnight stays.
- Pregnancy services - this includes before birth care, after birth care, and newborn services.
- Prescription drugs - for authorized drugs and refills.
- Pediatric services - this includes both dental and vision insurance (for children only), as well as general child health services.
- Mental health and substance abuse services - this would include counseling, behavioral health treatments, and psychotherapy.
- Rehabilitative services - this includes any help prescribed to recover physical or mental capabilities following an accident, injury, health issue, or disability diagnosis.
- Laboratory services - this could include blood work and other cultures.
- Preventative and wellness services - this includes annual appointments and chronic disease management services.
How to add dental and vision insurance services
Obamacare does not require dental and vision insurance as an essential service for adults (it is required of all healthcare plans for children). However, if you’re an adult seeking dental and vision insurance, you can still purchase plans through the marketplace. There are two ways to do this.
One option is to search for a plan that offers bundled health, vision, and dental services. The other is to search for supplemental, standalone vision, and/or dental health insurance plans. You can purchase these plans in addition to a healthcare plan.
FAQs about Obamacare
Can I get Obamacare if I have a pre-existing condition?
Yes, if you enroll during open enrollment periods, you’ll receive health insurance coverage for pre-existing conditions through the healthcare marketplace. By marketplace rules, all insurance plans must offer coverage for pre-existing conditions, and insurance companies are not allowed to deny you coverage because of a pre-existing condition. This includes pregnancy, which is covered on your first day of enrollment.
The only exception to this rule involves individual health insurance plans purchased prior to March 24, 2010. These are plans that were grandfathered into the marketplace and they can deny coverage based on pre-existing conditions.
How much will I save with a marketplace health insurance plan?
Depending on your financial situation and household size, you may meet eligibility requirements for financial assistance through the marketplace. The best way to determine how much you could save is by creating an account through healthcare.gov. You can also use this free insurance premium calculator offered through the federal government to give you an idea of what you should expect your payments to be and if you’ll be eligible for any savings.
Should I apply for Medicaid or Obamacare?
You might be eligible for Medicaid depending on where you live and how much money you make annually. Low-income families, pregnant women, children, and anyone receiving SSI (Supplemental Security Income) are eligible for Medicaid. In addition, your state might have expanded coverage options and plans available for different groups of people. Medicaid is different than Medicare, the U.S. national health program for those 65 and older
You can easily find out if you qualify for Medicaid in your state when you submit an application through the healthcare.gov website. If you do not qualify for Medicaid, then you’ll be able to check to see if you’re eligible for financial assistance with a marketplace health plan.
Can I enroll in marketplace insurance at any time?
Most individuals can only enroll in marketplace insurance during open enrollment periods at the end of each year. However, President Biden has issued an extended open enrollment period running from February 15, 2021, through May 15, 2021. This means anyone can apply for a marketplace health plan during this period.
Typically, you can only apply for health insurance through the marketplace outside of open enrollment if you qualify for a special enrollment period. This generally happens when you experience a life change event, such as having a baby, losing your existing coverage, getting married, or moving.
You can apply for CHIP or Medicaid at any time.
Am I required to pay back discounts received on Marketplace insurance?
When you apply for insurance through the marketplace, your financial assistance is calculated based on your expected yearly salary. If you end up making more money than expected (which will be reported to the IRS when filing tax returns), you may owe at the end of the year. This financial assistance is actually a premium tax credit that you’re opting to take in advance to save more on your monthly health insurance cost.
If your annual income is below 400% of the federal poverty level, there’s a limitation put in place on what you’ll need to pay back. However, if you’re above this level, you’ll need to pay back the entire amount of assistance you received and were not technically eligible for.
How many Americans do not have health insurance?
As of the last reporting, there are 29 million Americans without health benefits or insurance.
Is Obamacare the same thing as the marketplace?
The Affordable Care Act of 2010 (also referred to as Obamacare) is a comprehensive health care law that allowed Americans access to affordable health insurance and financial assistance through the open marketplace.
The bottom line
If you recently lost your job benefits, do not have health insurance, or pay a high cost for medical insurance, it may be worth reviewing your options during this extended special open enrollment period. Those below 400% of the poverty level will be able to receive financial assistance on marketplace plans and can also find out if anyone in their household qualifies for Medicaid.