How to Get Healthcare Coverage Before Open Enrollment Ends

In March, as COVID-19 began to spread throughout the U.S., igniting a national public health crisis, Sarah Fulton turned 26 and found herself without health insurance. Her birthday meant she no longer qualified for coverage under her parents’ insurance plans. Without employer coverage, Fulton took on the task of enrolling in Marketplace coverage through the Affordable Care Act (ACA).

She is one of many people have found themselves without insurance this year due to unemployment, death in the family, aging out of parental coverage, or experiencing another major life event. During last year’s open enrollment period, 11.4 million Americans signed up for coverage, according to the New York Times. The Commonwealth Fund estimates that as many as 7.7 million people lost their employer-sponsored insurance as of June, impacting 14.6 million people when including dependents. Experts expect that before the open enrollment period ends on December 15, millions more people will sign up compared to last year.

For people who have lost employer-provided insurance or are otherwise uninsured, experts recommend researching their options and choosing a marketplace or Medicaid plan before the enrollment period is up.

“If you have marketplace insurance, you have until December 15 and then you could be sort of out of luck until next year,” Aleka Gürel, manager of policy and partnerships at HealthSherpa, tells Verywell. “We hope that folks will come and screen and find out what they qualify for and complete that process, so they have coverage when they really need it.”

Getting Care through the ACA

Through the Affordable Care Act, insurance through the federal marketplace is available in 36 U.S. states. Fourteen other states and D.C. offer plans through their own marketplaces.

In 2010, the ACA:

• Made it illegal to deny coverage for people with chronic conditions or working high-risk jobs
• Imposes a cap on out-of-pocket spending
• Requires most plans to cover dozens of preventative care services
• Allows people to access birth control at low to no out-of-pocket cost

People who lose employer-provided health insurance may enroll in marketplace coverage within 60 days of a job loss, or during the open enrollment period. In states which have expanded their Medicaid program, people can become eligible for plans at any time when their income drops below a certain level.

HealthSherpa is the largest private channel for enrollment outside of HealthCare.gov. Gürel says that total enrollment in the health plans through the company has about doubled this year, and enrollment in Medicaid plans tripled in the spring.

As in years past, shoppers can choose from plans at four levels: bronze, silver, gold, and platinum. Marketplace premium rates remain roughly the same or lower this year, due to insurers’ record profits last year. Additionally, some insurance providers like United Health have re-entered the marketplace or are expanding their coverage options.

Depending on your income, you may qualify for a plan with tax credits to help offset the cost of premiums, copayments, coinsurance, and deductibles. In more than 38 states, you can get free or low-cost coverage through Medicaid and the Children’s Health Insurance Program if you make less than $1,400 per month.

“The number one takeaway is that even if you’ve never engaged with this before, take five minutes, see what you qualify for,” Gürel says. “Often people are pretty surprised to see how affordable the options are.”

Protection During a Pandemic

After her twenty-sixth birthday, Fulton had one month to terminate her previous insurance and find a new plan. As she tried to coordinate the paperwork with her old insurer, her father’s employer, and the Department of Health and Human Services, she was slowed by hiccups in the system as people responded to COVID-19-induced changes. She says she spent hours on hold, taking time out of her workday to navigate the system.

“I’m very lucky that I got to work from home and make those calls,” Fulton says. “I think about the people that have to navigate the system and are either taking the time off of work or don’t have the flexibility to navigate those calls.”

Fulton says she had the healthcare vocabulary to understand how plans differed based on their cost and the coverage they provide. Still, she sought the advice of experts from HealthCare.gov to clarify her options and ensure she made an informed decision. 

“if you don’t know what premiums and deductibles and a lot of that is, it’s like a second language,” she says.

When choosing her plan, Fulton says she prioritized options that allowed her to pay relatively low rates for doctor’s visits and prescriptions, and to keep her doctor in-network. As someone with allergies, her plan allows her to feel secure in visiting the doctor more than once a year without exorbitant co-pays. Still, despite her coverage, she says she fears what will happen if she experiences a health emergency.

“There’s not a lot of clarity on what anything actually costs until it happens,” Fulton says.

During a nation-wide pandemic, receiving coverage can be crucial. There are no federal regulations on COVID-19 testing prices, and in counties where free COVID-19 testing isn’t easily accessible, people who are uninsured may have to pay hundreds of dollars to get tested.

Weighing Multiple Plan Options

People who are offered health care through their employer often only need to choose from a few insurance options. On the exchange however, people seeking insurance may need to sift through dozens of options.

“For people who are in this boat where they’ve had employer coverage their whole life and they’ve had to deal with one or two plans and that being an easy choice, going from that to potentially dozens can be really tricky,” Gürel says.

This task can seem daunting, she says, but it’s important to focus on:

• Which plans you can afford
• Which give you high subsidies
• Which give you access to the doctors and prescriptions you need

During a year in which many people’s incomes and employments statuses are fluctuating, it may seem challenging to predict how much income a person is able to spend on healthcare needs. Gurel recommends people keep track of and report any income changes their household may experience throughout the year. This way, you may avoid being charged for subsidies at the end of the year in your taxes.

Reading the Fine Print and Seeking Help

There are a number of middle-man insurance brokers who sell health coverage plans apart from HealthCare.gov. While some of these sites offer support, others may sell options that don’t qualify under ACA rules, like short-term care plans, healthcare sharing ministries, or plans that aren’t even certified as insurance.

In order to avoid purchasing a shoddy option, Gürel recommends checking that plans include things like birth control and mental health care, which must be covered under the ACA.

“Read the fine print and make sure it is going to cover those pre-existing conditions and is going to have a limit on what you pay in a year rather than what they pay in a year,” Gürel says.

To ensure your selected plan will cover your needs for the year, she says to keep a list of prescriptions you’ll need, specialists you plan to see, procedures you hope to schedule, and out-of-pocket costs you may need to cover. If you plan to have a child, an elective surgery, or other procedures that could incur high costs, factor that into your decision-making.

“If you have any doubts at all, it is so worth it to hop on the phone and talk to a human because there is just a ton of information that you can really get wrong if you try and make assumptions about what things mean,” Fulton says. “It’s better to talk to someone who wants to help you.”