Affordable Care Act (ACA) Open Enrollment Season 2021: Educating the Public about their Health Insurance Options
Atyya Chaudhry, AMCHP Senior Program Manager, Health Systems Transformation
Sara Cariano, Virginia Poverty Law Center, Enroll Virginia
In 2018, prior to the COVID-19 pandemic, the uninsured population in the U.S. was approximately 30 million, representing roughly 5 percent of children and 13 percent of adults ages 19 through 64. Higher uninsured rates fell disproportionately on communities of color, including American Indian/Alaskan Native, Black, and Hispanic populations. The persistent lack of insurance coverage affects all populations including women, children, and families. Further exasperating this issue is the pandemic. The Commonwealth Fund recently estimated that nearly 7.7 million individuals, including women of reproductive age, lost employer-sponsored insurance as of June 2020 due to the COVID-19 pandemic. With touchpoints throughout the community and partnerships with state and local service agencies, MCH programs are well positioned to actively promote, support, and educate the public about the open enrollment season.
The ACA open enrollment season began Sunday, November 1, 2020, and runs through Tuesday, December 15, 2020. Open enrollment is facilitated through the federal web portal, Healthcare.gov, also known as the ACA Marketplace. Open enrollment season is an opportunity for families to review their health care plans and choose an option that meets their needs. Those with an income between 100 percent ($26,200 for a family of four) and 400 percent of the federal poverty level (FPL) ($104,800 for a family of four) may qualify for financial assistance to purchase a plan through the Marketplace. The ACA Marketplace will also do a Medicaid assessment for those who apply (in most states, adults with incomes below 133 percent the FPL qualify for Medicaid coverage). Medicaid and the Children’s Health Insurance Plan (CHIP) are open year-round for enrollment.
Outside of the open enrollment season, individuals may be eligible to sign up for insurance through the ACA marketplace if they have a qualifying life event that triggers a special enrollment period (SEP). The most common reason for an individual to qualify for an SEP is the loss of current health coverage. Rising numbers of people are losing employer-sponsored health insurance during the COVID-19 pandemic and will qualify on that basis. Other qualifying life events are as follows:
- Changes in the household situation, such as marriage or the birth or adoption of a baby
- Moving to an area where the plan options are different or moving from a foreign county
- Gaining lawfully present immigration status
- Leaving incarceration
- Gaining membership in a federally recognized tribe.
Healthcare.gov will screen individuals for SEP eligibility and local assisters can help consumers understand and apply for insurance during SEPs.
AMCHP has developed resources to support MCH programs as they engage in open enrollment activities. The AMCHP Health Systems Transformation team is available to connect with your jurisdiction to discuss in more detail open enrollment activities. If you are interested in receiving assistance, please reach out to Atyya Chaudhry at Achaudhry@amchp.org.