Health Insurance for 2021

Health Insurance Affordable Care Act

How can I acquire Health Insurance in 2021?

We assist individuals and families with enrollment in the Affordable Care Act (ACA), also known as Obamacare. Open Enrollment was from November 1 to December 15, 2020 for plan year 2021.

However, we help folks throughout the year that have a (QLE) Qualifying Life Event.

Qualifying Life Event (QLE)

What is a QLE? It’s a change in your situation — like getting married, having a baby, or losing health coverage. This can make you eligible for a Special Enrollment Period. Which would allow you to enroll in health insurance outside the yearly Open Enrollment Period.

ACA Purpose

The Affordable Care Act of 2010 was designed to lower the healthcare costs for the federal government. With actual cost this year – 2020 – coming in at over $1 Trillion it’s no wonder the government was looking for some relief.

Since hospital visits (ER) are the most expensive treatment, their goal was to significantly reduce those visits through prevention by mandating that everyone have insurance. With insurance, an individual could seek preventive treatment and hopefully ward off a critical care situation.

In theory, this would reduce ER visits thus reducing costs. Of course, the requirement of having insurance is no longer in place. Only time will tell when costs increase due to individuals not having preventive care.

ACA Essential Health Benefits

Obamacare’s 10 essential health benefits are required of all health insurance plans to comply with the Affordable Care Act (ACA)

  1. Preventive and wellness visits
  2. Maternity and newborn care
  3. Mental and behavioral health treatment
  4. Services and devices for injuries, disabilities, or chronic conditions
  5. Lab tests.
  6. Pediatric care. Dental and vision included
  7. Prescription drugs
  8. Outpatient care 
  9. Emergency room services
  10. Hospitalization

Health Insurance 2021 Metal Plans

  • Bronze – usually the lowest premiums, pays 60% of your costs
  • Silver – pays 70% of medical costs, but premiums are higher
  • Gold  covers 80% of your costs
  • Platinum  covers 90% of your costs, but has the highest premiums

Healthcare Exchange

Exchanges or Marketplaces are websites run by your state or the federal government. These websites show plan options and your eligibility for a subsidy. They open for enrollment each year in November.

Over 11 million Americans used the exchanges to purchase insurance last year, and 80+ percent of them received a subsidy.

Health Insurance Subsidy

Eligibility for a subsidy depends on your household income. Income must be between 100% and 400% of the Federal Poverty Level. But there are other stipulations as well –

  • you must not have access to Medicaid
  • or be qualified for a employer-based health plan

The easiest way to see if you qualify for a subsidy is to CLICK HERE.

You’ll enter your zip code, expected adjusted gross income, household size, age, gender and tobacco use and it will tell you how much of a premium discount you qualify for. You can then sign up for a plan if you have a qualifying life event (QLE).

The subsidy chart below shows the maximum income level based on household size (400% federal poverty level) that still qualifies for a subsidy in 2020.

**Actual limits may vary by state, these are the general federal levels**

Income Limits by Household Size for 2020

Source: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation

More Key Components to ACA

  • No pre-existing condition clause, insurance company can’t deny coverage
  • Insurance companies can’t raise payments without State approval
  • Insurers must spend at least 80% of premiums on medical services
  • Insurance company can’t drop you from a plan for being sick
  • Parents can have adult children (up to age 26) on their plans

Health Insurance for 2021 Final Thoughts

There are several steps to enrolling for an ACA plan but it doesn’t have to be overwhelming. We help folks with enrollments during open enrollment and throughout the year. If you have questions about a plan contact us anytime.

Want to check out the plans, or to just learn more click the button below. You can look at plan options, benefits, drug coverages, etc. If you find a plan that fits, you can sign up within minutes.