Pinnacle Wealth Planning Services, Inc. —

The portal opened Nov. 1 for Individuals (including families) to apply for new health insurance, switch to a different health-care plan, or re-enroll in their current plan through a Health Insurance Marketplace under the Affordable Care Act (ACA). The open enrollment period for 2021 health coverage ends on Dec.15, 2020.

If you don’t have health insurance through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source that provides qualifying health coverage, the Marketplace can help you get covered. If you have job-based insurance, you can buy a plan through the Marketplace, but you’ll pay full price unless your employer’s insurance doesn’t meet certain standards. Most job-based plans do meet the standards. If you have Medicare, you can’t switch to Marketplace insurance, supplement your coverage with a Marketplace plan, or buy a Marketplace dental plan.

Individuals can use Health Insurance Marketplaces to compare health plans for benefits and prices and to select a plan that fits their needs. Dec.15 is the deadline to enroll in or change plans for new coverage to start Jan. 1, 2021. For those who fail to meet the Dec. 15 deadline, the only way to enroll in a Marketplace health plan is during a special enrollment period. To qualify for special enrollment, an individual must have a qualifying life event such as a change in family status (for example, marriage, divorce, birth, or adoption of a child), change in residence, or loss of other health coverage (e.g., loss of employer-based coverage, loss of eligibility for Medicare or Medicaid). Also, only plans sold through a Health Insurance Marketplace qualify for cost assistance.

Since the portal opening Nov. 1, you can apply for health insurance coverage in a number of ways: online (through the federal Marketplace website, healthcare.gov), by phone, through an agent/broker, through certified enrollment partner websites, or with a paper application.

Changes to the Affordable Care Act for 2021

There are several policy changes related to the pandemic that may affect enrollment and the cost of insurance, including:

Many states run their own marketplaces and have established special enrollment periods due to the virus. Check with your state’s department of insurance for specific open enrollment dates.
Some marketplace insurers offered additional premium discounts or rebates to policyholders in 2020. These discounts will not impact consumers’ eligibility for premium tax credits, nor affect the tax reconciliation process (an adjustment in your premium cost based on changes to your income).
People who purchased an individual plan of insurance outside of the marketplace and who experience a decrease in income that makes them eligible for advanced premium tax credits, may be eligible to use the special enrollment period to enroll in a marketplace plan. However, this may not be available in all states. Contact your state insurance department to determine eligibility.
Eligible organizations including employers, insurers, and universities may exclude contraceptive coverage on the basis of “sincerely held religious beliefs or moral convictions.”

If you have questions about obtaining health insurance and the applicable tax implications of your choices, contact the tax experts at Pinnacle CPA Advisory Group for help. Call us at at (614) 942-1990, send email to info@cpaagi.com, or just fill out the Contact Form at cpaagi.com/contact.