Last Updated: October 14, 2020
The 2021 Open Enrollment Period runs from Sunday, November 1 to Tuesday, December 15, 2020. You can use HealthCare.gov to apply and enroll in health coverage. If your state appears on the list below, you will use your state’s website to enroll in health coverage:
There are many factors to consider when selecting health insurance.
1. Decide how you will obtain health insurance.
There are four options for getting health coverage:
- Your employer.
- Federal marketplace or exchange (healthcare.gov).
- Your specific state’s marketplace or exchange.
- A private exchange or directly from a private insurer.
2. Determine which type of plan is best for you.
After deciding how you will obtain health insurance, you must determine which type of plan is the best fit for you. There are four main types of health plans- HMO, POS, EPO, and PPO- each with different benefits and drawbacks. To compare these different plan types, consider the factors outlined in the chart below. Ask yourself which of these factors is most important to you, and then use the chart to determine which plan best fits your needs.
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HMO
Health Maintenance Organization
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POS
Point-of-service
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EPO
Exclusive Provider Organization
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PPO
Preferred Provider Organization
|
|
Does the plan require you to select a designated Primary Care Physician?
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Yes
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Yes
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Sometimes
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No
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Does the plan require you to get a referral if you want/need to see a Specialist?
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Yes
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Sometimes
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No
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No
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Does the plan cover health expenses from doctors, hospitals or providers within the Provider Directory?
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Yes
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Yes
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Yes
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Yes
|
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Does the plan cover health expenses from doctors, hospitals or providers outside of the plan’s network?
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No
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Yes
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No
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Yes
|
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How expensive will your monthly payments be? |
$
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$$
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$$
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$$$$
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Can you use a Health Savings Account to set aside pre-tax money to pay for costs not covered by your plan?
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Sometimes |
Sometimes |
Sometimes |
No |
Does the plan have very high out-of-pocket costs for health expenses, but very low regular monthly payments?
|
Sometimes |
Sometimes |
Sometimes |
No |
3. Compare Plans.
Consider the following factors when deciding what type of plan to select:
- The benefits covered.
- The "provider directory" which features the clinics and doctors that participate in the plan’s network.
- Cost.
4. Determine your monthly cost.
Premiums are the monthly costs you pay for your health insurance, and deductibles are the out-of-pocket costs you must personally pay for your health expenses. Typically, paying higher monthly premiums allows for lower deductibles, and paying lower monthly premiums causes higher deductibles.
To decide if you want a high premium/low deductible plan or a low premium/high deductible plan, consider how often you will be using health services. A plan with a higher premium which covers a higher portion of your medical costs may be appropriate if:
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You are expecting a baby or plan to have a baby.
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You have a surgery coming up.
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You need emergency care frequently.
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You’ve been diagnosed with a chronic condition.
Options for managing out-of-pocket costs:
If you are considering a “High Deductible Health Plan” that has very low monthly costs (also known as "premiums") and very high out-of-pocket costs (also known as "deductibles"), determine what options the plan allows for managing the out-of-pocket costs you may incur. Some High Deductible Health Plans allow you to use the following alternative sources to help pay for your out-of-pocket payments.
Federal law no longer requires individuals to purchase health insurance, however, the following individual states have an individual mandate as of 2020:
- Massachusetts
- New Jersey
- Vermont
- California
- Rhode Island
- Washington D.C.
Individuals who live outside of these states who do not purchase health coverage for the year of 2020 will not have to pay a fine.
Qualifying Health Coverage
For people who are unable to afford traditional health insurance, below are some available options. Please note that if you are concerned about your ability to afford health insurance, it is best to seek advice and assistance from a professional. Many states have Guides, Navigators, or Application Assistants to answer your questions and can walk you through this process, free of charge. Visit Healthcare.gov or your state’s Exchange website to get in touch with one of these individuals.
Medicaid and Children’s Health Insurance Program (CHIP):
If you have little or no income, you may qualify for health coverage through a state agency. Medicaid and Children’s Health Insurance Program provide free or low-cost coverage to millions of Americans based on need. You can apply for Medicaid or CHIP through either the Health Insurance Marketplace or your state’s Medicaid agency.
Catastrophic Coverage:
Catastrophic health plans are a low-cost option you can buy through the healthcare marketplace. To meet eligibility requirements for catastrophic coverage, you must be under 30 years old or qualify for a hardship exemption due to your inability to afford all other insurance options. These plans cover the same services as other medical insurers with relatively low monthly premiums, but very high deductibles.
Short Term Health Insurance:
Short term health insurance is available outside of the marketplace, and you do not have to meet any income standards to qualify. These plans have low monthly premiums, however they are set for a designated length of time and provide a limited set of benefits. These plans are not Qualifying Health Coverage (do not meet Affordable Care Act requirements).
Supplemental Products:
Supplemental products are add-ons to other limited plans you might have, such as a Short Term Health Insurance plan. These supplemental products can help expand your coverage and build a safety net to avoid financial trouble. Some people might even use supplemental products on their own if they cannot afford health insurance. Examples of supplementary products are insurance plans specifically for dental, vision, accidents, hospitalization, or critical illness.
Advanced Premium Tax Credit:
An Advanced Premium Tax Credit (APTC) can help you lower you monthly health insurance premiums. When you apply for coverage through the Health Insurance Marketplace, you provide an estimated expected income for the year. If this estimate allows you to qualify for a premium tax credit, you can apply the credit to lower your premium payments.
