Reopening of ACA Health Insurance

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President Joe Biden today signed an executive order that will reopen the sign-up period for Affordable Care Act healthcare plans for 90 days, so people without insurance can still get coverage for 2021.  

Normally, the sign-up period—known as open enrollment—ends in December, and only people who experience an event such as a job loss, a divorce, or the birth of a child can buy insurance outside of the open enrollment time frame. Today’s new rule means that for three months beginning Feb. 15 you won’t need a qualifying reason to sign up for coverage at HealthCare.gov, the federal government’s marketplace for ACA plans.

In a statement before today’s signing, Biden said that “every American has a right to the peace of mind that comes with knowing they have access to affordable, quality health care.”  

“As we continue to battle COVID-19, it is even more critical that Americans have meaningful access to affordable care,” the White House also said.

An estimated 14.6 million people have lost employer-provided health insurance because of COVID-19, according to an October 2020 analysis by the Commonwealth Fund. That number includes the 7.7 million workers who lost their jobs, as well the family members their policies covered.

Biden’s new order does not apply to the 14 states (California, Colorado, Connecticut, Idaho, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, and Washington) plus Washington, D.C., that run their own marketplaces and already extended their signup periods. But it does apply to the 36 other states where the healthcare marketplaces are run by the federal government. Under the Trump administration, the federal exchange had not offered an extended special enrollment period for consumers in those states, says Cynthia Cox, vice president and health economic policy researcher at the Kaiser Family Foundation.

Many people who could have benefited from open enrollment in the fall might not have been aware of it because “the Trump administration dramatically cut funds to advertising” related to the healthcare plans, says Timothy Jost, a professor emeritus at Washington and Lee University who studies health policy.  

He says the Biden administration will push enrollment much more aggressively in the hope of getting people signed up, especially lower-income people and those in rural areas, as well as those who lost their jobs or never had insurance to begin with.

“After years of policies that weaken ACA marketplaces, this serves as an opportunity to get more people covered,” says Loren Adler, associate director at the USC-Brookings Schaeffer Initiative for Health Policy at the University of Southern California in Los Angeles.

The executive order doesn’t take effect immediately, at least in part to give the Department of Health and Human Services time to create a marketing campaign to promote signing up for insurance to consumers, Cox says. She estimates there is almost a billion dollars in promotional funds available that went unspent during the Trump administration. Marketing and outreach are essential, Cox says, so people know what is available.

Why You Might Not Need to Wait

In certain situations, you can sign up for health insurance now at HealthCare.gov, without waiting for the executive order to go into effect. They are:  

You had a life-changing event in the past 60 days. If you lost your job in 2021, moved, got married, divorced, or added a child to your household, you can sign up for health coverage now at HealthCare.gov within 60 days of the event.

You lost health insurance any time in 2020 because of COVID-19. For example, if you had to drop insurance you bought for yourself because of income loss—or if you think you will need to drop coverage in the next 60 days for COVID-19-related income reasons—you can still apply for coverage on federal marketplace plans.

Other Options to Know About

Depending on your circumstances, there may be additional avenues available to you.

See if you qualify for Medicaid. If you lost your job or had reduced income, you could be eligible for your state’s Medicaid program. Income qualifications in each state vary, but many people earning 138 percent of the poverty level or less, about $17,774 for an individual and $36,570 for a family of four, are eligible. Go to HealthCare.gov to see whether you qualify.  

Twelve states—Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming—limit Medicaid to specific, low-income groups of people such as the elderly, parents, pregnant women, and the disabled. If you live in one of these states and aren’t sure if you’re eligible—particularly if you have children—HealthCare.gov suggests that you apply anyway because the application process itself, which involves providing detailed information about income and dependents, will help to clarify whether you qualify or not.  

You might be eligible for a reduced-cost ACA plan. If you don’t qualify for Medicaid and earn up to $51,040 for an individual or $104,800 for a family of four, you may be among the 85 percent of people eligible for reduced rates on a plan from HealthCare.gov. The average monthly premium of such plans is about $87, according to , a group that helps consumers find insurance and tracks plan premiums.

If you already have an ACA plan, and you or someone in your household has lost income this year, you may qualify for a larger subsidy. Cox says to log in at HealthCare.gov and report your income change to determine whether you can pay less on your monthly premium.

Uninsured? Consider a federally funded health clinic or charity care. If you don’t have any coverage, you don’t need to forgo necessary medical care. There are more than a thousand federally funded and charity medical centers throughout the U.S., some of which have on-site pharmacies where you can fill prescriptions for low or no cost. The Health Resources & Services Administration can help you find a health center near you that’s federally funded. To locate a charitable clinic or pharmacy in your area, use the Find a Clinic tool run by the National Association of Free and Charitable Clinics.

Avoid “short term” health insurance plans. While these have much lower monthly costs compared with ACA plans, they aren’t required to provide essential benefits such as maternity and mental health care, Jost says.  

These plans can also deny coverage for preexisting conditions, including COVID-19, according to a May 2020 Congressional Research Service report.  

Short-term plans, which may be offered for as few as three months or for up to 36, may “look like a bargain, but they’ll probably be of little use if a person really gets sick,” Jost says. What’s more, the savings may not be that substantial, given all you give up. For example, , an online health insurance broker, found that for a family of three, one of the lowest-cost ACA plans with the federal subsidy would cost $297 monthly. For a short-term plan, the monthly premium was $116.

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