Everything you need to know to enroll in an affordable individual-market health insurance plan during the 2021 open enrollment period
When is open enrollment for 2022 health coverage?
Open enrollment for 2022 health coverage begins nationwide on November 1, 2021. In the majority of the states, it will continue through January 15, 2022, although enrollments in most states will need to be completed by December 15, 2021 in order to have a plan that takes effect January 1 (enrollments completed after December 15 will be effective February 1 in most states). For most Americans, November 1, 2021 is the next opportunity to enroll in an ACA-compliant health plan without needing a qualifying life event. But in states that use HealthCare.gov, enrollment in 2021 coverage is still available for people who are receiving or have received unemployment compensation in 2021. And there are some state-run health insurance exchanges where enrollment in 2021 health coverage is still open, with the following deadlines:
- California: Through December 31
- Connecticut: Through October 31
- DC: Through the end of the pandemic emergency period
- Minnesota: The general COVID-related special enrollment period has ended, but people who have received unemployment compensation in 2021 can still enroll or change to a $0 premium silver plan)
- New Jersey: Through December 31
- New York: Through December 31
In most of the country, the COVID-related special enrollment periods ended on August 15 or earlier. But depending on the circumstances, some people have access to year-round enrollment in various programs, including:
- Medicaid or CHIP, for people who meet the eligibility requirements.
- Basic Health Programs in New York and Minnesota.
- The new Covered Connecticut program (enrollment is available through the end of 2021).
- The ConnectorCare program in Massachusetts (for people who are newly eligible or who haven’t enrolled before).
- Native Americans.
Use our calculator to estimate how much you could save on your ACA-compliant health insurance premiums.
Subsidies normally only extend to households with income up to 400% of the poverty level, but that limit has been removed for 2021 and 2022, under the terms of the American Rescue Plan. For these two years, there is no longer a subsidy-cliff; instead, people with an income of 400% of the poverty level or higher are eligible for a subsidy if the benchmark plan would otherwise cost more than 8.5% of their household income.
For people with lower income, the American Rescue Plan also reduces the percentage of income they have to pay for the benchmark plan, as illustrated in this comparison. (In addition to the federal subsidies, New Jersey, Massachusetts, Vermont, Maryland, Washington, and Connecticut offer additional state-based subsidies for some enrollees.)
Here’s how household income is calculated under the Affordable Care Act’s rules. It’s referred to as MAGI, for modified adjusted gross income, but it’s not the same as the general MAGI calculations you may be familiar with in other circumstances. There are also steps you may be able to take to reduce your MAGI and thus increase the amount of subsidy for which you’re eligible.
As of early 2021 (before the American Rescue Plan’s (ARP) subsidy enhancements were implemented), there were more than 9.7 million people receiving premium subsidies in the exchanges nationwide, and their average subsidy amount was more than $485 per month.
In August 2021, CMS reported that families were seeing an average additional savings of $40 per month due to the ARP’s subsidy enhancements. If you haven’t checked to see if you could get financial assistance with your health insurance, it’s in your best interest to do so — especially now that the American Rescue Plan has made subsidies larger and more widely available for 2021 and 2022.
(Note that the Build Back Better Act would extend the ARP’s subsidy enhancements, making some of them permanent. This legislation is under consideration in Congress in the fall of 2021.)
What information will I need in order to enroll in a health insurance plan for 2022? You can enroll in a health insurance plan online, over the phone, or in-person. Regardless of the method, if you’re enrolling in a plan through the exchange, you’re going to need to have the following information on hand for each enrollee:
- Name, address, email address, social security number, birthday, and citizenship status. (Proof of lawful residency status may be required).
- Household size and income (if you’re planning to apply for premium subsidies or cost-sharing reductions). A wide range of documentation can be used to prove your income, including pay stubs, W2s, your most recent tax return, etc.
- Coverage details and premium for any employer-sponsored plan that’s available to your household (regardless of whether you’re enrolled in that plan or have declined it).
- Payment information that the insurer will be able to use to charge your premiums.
- Your doctors’ names and zip codes, so that you can check to make sure they’re in-network with the health plans you’re considering.
- A list of medications taken by anyone who will be covered under the policy. Each insurance plan has its own formulary (covered drug list), so you’ll want to check to see which one will best cover the medications you need.
- If you want to enroll in a catastrophic plan and you’re 30 or older, you’ll need hardship exemption (note that premium subsidies cannot be used with catastrophic plans, so these are generally only a good idea if you don’t qualify for a premium subsidy, but can meet the requirements for a hardship exemption).
When will my ACA-compliant health insurance plan take effect?
In almost all cases, your coverage will take effect on January 1, 2022, if you sign up during the open enrollment window in the fall of 2021. If you are already enrolled in an individual-market plan and you pick a different plan during open enrollment, your current plan will end on December 31 and your new plan will take effect seamlessly on January 1 (assuming you continue to pay all of your premiums when they’re due). If you’re enrolling in 2022 coverage after December 15, 2021, your plan will likely take effect on February 1, 2022. This will be the case in the 33 states that use HealthCare.gov as their marketplace, although deadlines will vary from one state to another in the remaining states (some of the states that run their own exchanges will also allow people to enroll after January 15; see details for your state here).
If you’re currently uninsured and waiting for a plan to take effect, a short-term medical plan can bridge the gap for you, as long as you’re fairly healthy. Short-term plans are available in most states, and the coverage can take effect as soon as the day after you purchase your plan. So a short-term plan can provide peace of mind just in case you end up with an unexpected emergency before your new coverage takes effect. (You can select your state on this page to see how short-term plans are regulated and which options are available to you).
But note that short-term plans should not be thought of as a viable replacement for regular individual major medical coverage. If you’re relying on one temporarily, you’ll definitely want to sign up for an ACA-compliant plan during open enrollment.
If you enroll during the open enrollment period but you also have a qualifying event, you may be able to get coverage before the start of 2022. For example, if you get married and apply for coverage in November, you could have a December 1 start date if you use your special enrollment period, whereas you’ll have a January 1 effective date if you just enroll under the normal open enrollment period rules.
So if your special enrollment period overlaps with open enrollment, you might want to utilize your special enrollment period in order to get an earlier effective date. But keep in mind that the plan will then renew on January 1, which means you’ll have a nearly immediate rate change and potential benefits change for the new year (for 2022, rates are decreasing for some plans and increasing for others; the specifics will depend on the plan you select).
What happens if I don’t enroll in a plan during open enrollment?
If you don’t enroll in an ACA-compliant health insurance plan by the end of open enrollment (January 15, 2022 in most states), your buying options will be limited until the next open enrollment starts in the fall of 2022.
Depending on the circumstances, there are various options for obtaining coverage, even after open enrollment ends:
Medicaid enrollment is year-round
Medicaid and CHIP enrollment are available year-round for those who qualify. If your income drops to a Medicaid-eligible level later in the year, you’ll be able to enroll at that point. Similarly, if you’re on Medicaid and your income increases to a level that makes you ineligible for Medicaid, you’ll have an opportunity to switch to a private plan at that point, with the loss of your Medicaid plan serving as the qualifying event that triggers a special enrollment period.
Monthly enrollment opportunity if your household income doesn’t exceed 150% of the poverty level
In September 2021, the Biden administration finalized a new monthly enrollment opportunity for people whose household income doesn’t exceed 150% of the federal poverty level. This enrollment opportunity will remain in place for as long as the American Rescue Plan’s subsidy structure (which grants premium-free benchmark plans to people at this income level) remains in place. That’s at least through the end of 2022, and possibly longer if Congress extends the ARP’s subsidy structure.
Native Americans can enroll year-round
Native Americans can enroll in plans through the marketplace year-round. Here’s more about special provisions in the ACA that apply to Native Americans.
Special enrollment period if you have a qualifying event
If you have a qualifying event during the year, you’ll have access to a special enrollment period (SEP). Qualifying events include marriage (assuming at least one spouse already had coverage prior to the marriage), the birth or adoption of a child, loss of other minimum essential coverage, or a permanent move to a new geographical area where the available health plans are different from what was available in your prior location (assuming you already had coverage prior to your move).
Here’s a full guide to all of the qualifying events that trigger special enrollment periods in the individual market, including details about the specific rules that apply to each of them.
Short-term health insurance
Under general federal rules, short-term health insurance plans can have initial terms of up to 364 days and a total duration of up to 36 months, including renewals. But the majority of the states placed more restrictive limits on the availability of short-term plans, and those state limits supersede the new federal rules.
Is there a penalty for not having insurance?
There is no federal government penalty for being uninsured in 2022, but you still need coverage! The ACA’s federal individual mandate penalty has been $0 since the start of 2019, and that continues to be the case for 2022. People who are uninsured do not face a penalty, unless they’re in a state that has its own individual mandate and a penalty for non-compliance. Four states and DC impose tax penalties for not having health insurance:
- Massachusetts
- New Jersey
- California
- Rhode Island
- District of Columbia
Can I preview health plans and prices?
Yes! In every state, you can browse the available plans anonymously before you create an exchange account. If you want to see rates and plan options, the information is available – online, in-person, and by phone. Here are some tips for finding it:
- Get a quote here at healthinsurance.org. You’ll want to select the option for “Affordable Care Act plans” when you’re using the shopping tool. But as noted above, if you’re also in need of a short-term plan to cover you until the end of December, you can also get quotes for those plans if you select the option for “short-term plans and alternatives” (keeping in mind that these should be thought of as a bridge plan until your ACA-compliant plan takes effect, rather than a replacement).
- ‘Window shop’ anonymously on your state exchange (if you’re in DC or one of the 17 states that run their own exchanges) or HealthCare.gov’s plan browsing page (if you’re in one of the other 33 states; note that as of the fall of 2021, Kentucky, Maine, and New Mexico are transitioning to their own enrollment platforms). The window shopping tools that are available through the exchanges are anonymous and do not require you to enter any identifying information; they offer a quick and easy way to get a good idea of what’s available to you. You can enter an estimate of how much you expect to earn in 2021, and the shopping tools will show you the amount of premium subsidy (premium tax credit) you’ll be eligible to receive (here’s how household income is calculated under the ACA).
- Consult with a trained advisor. Set up an appointment with a Navigator or broker in your area who will be able to help you sort through the available options and figure out which one will best meet your needs. (See below for more information about the enrollment assisters who can help you.)
- Talk with your health care providers. This is helpful especially if you’re considering a policy change during open enrollment. You’ll want to know which provider networks include your doctors, and whether any network changes are planned for the coming year.
Should I let my existing ACA-compliant health plan renew for 2022? If you’re already enrolled in an ACA-compliant health plan through your state’s marketplace, can you just let that plan automatically renew for 2022? In most cases, yes, assuming your plan will still be available next year. Auto-renewal is an option for nearly all exchange enrollees, although Maine, Kentucky, and New Mexico residents will need to claim their new accounts at their state-run exchanges, as those states are transitioning away from HealthCare.gov and enrollee data will be migrated to the new exchange platforms. But relying on auto-renewal is not in your best interest. No matter how much you like your current plan, it pays to shop around during open enrollment and see if a plan change is worth your while.
Here is why:
- In most states, you’ll have limited opportunities to pick a new plan after your coverage is auto-renewed. The auto-renewal process happens right after December 15, for people who haven’t manually renewed or selected a new plan. Starting with the open enrollment period in the fall of 2021, enrollees in most states will still have another month — through January 15 — to pick a new plan if they end up deciding that the auto-renewed option isn’t the best choice. If you do make a plan change in the latter half of December or the first half of January, your auto-renewed plan would cover you in January, and your new plan would take effect in February. But after January 15, in most of the country, you will not have another chance to change your coverage until the following year, unless you experience a qualifying event.
- Your subsidy amount will generally change from one year to the next. If your subsidy gets smaller, auto-renewal could result in higher premiums next year. As has been the case for the last couple of years, there are a plethora of new insurers entering insurance markets all across the country for 2022. This is good news in terms of competition and plan options. But if those plans are priced below the existing options, they can bring down the cost of the benchmark plan and reduce premium subsidies for everyone in the area. Shopping around for a different plan — as opposed to letting your plan auto-renew – might result in substantial savings.
- If you receive a subsidy, auto-renewal could be dicey even if the subsidy amount isn’t declining. If you rely on auto-renewal (as opposed to manually renewing and completing the financial eligibility determination process for the coming year), the exchange can renew your plan without a premium subsidy in certain circumstances. This includes situations in which you didn’t give the exchange permission to access your financial information in subsequent years, or if you failed to reconcile your premium subsidy on a prior year’s tax return (note that this is not applicable for 2020, as premium subsidies did not have to be reconciled for 2020). This is explained in more detail in this FAQ.
- If your plan is being discontinued, auto-renewal will result in the exchange or your insurer picking a new plan for you. They will try to assign you to the closest match to what you have now, but selecting your own new plan is a better option.
- Auto-renewal might result in a missed opportunity for a better value. Even if the plan you have in 2021 represented the best value for this year, there may be different plans available for 2022 (insurers are expanding their coverage areas and joining the exchanges in numerous states for 2022, and the American Rescue Plan’s extra subsidies might mean that you could upgrade your coverage at little or no additional cost). Provider networks and benefit structures can change from one year to the next, as can premiums. You might still decide that renewing your current plan is the best option for 2022. But it’s definitely better to actively make that decision rather than letting your plan auto-renew without considering the other available options.
Who can help me enroll in an ACA-compliant / Obamacare health insurance plan?
Health insurance is complicated, and many people want or need personal assistance with the application process and with ongoing insurance utilization questions. To fill this need, there are a variety of assisters nationwide who are trained to guide people through the process of researching and enrolling in health plans, and some can provide ongoing support after the plan is purchased.
Health insurance navigators
The health insurance Navigator role was created for the purpose of providing impartial education and outreach about the exchanges and exchange health plans, helping applicants determine whether they qualify for subsidies or Medicaid, and assisting them in the enrollment process. Standards and regulations for the Navigator program are outlined in 45 CFR 155.210 and CFR 45 155.215.
In early 2016, HHS laid out enhanced requirements for Navigators – most of which took effect for 2018 – including targeted assistance for underserved and uninsured populations, as well as post-enrollment assistance (on issues such as eligibility appeals and health insurance utilization). The enhanced requirements are detailed in 45 CFR 155.210(e)(9).
In the guidelines for 2020, HHS reversed course somewhat on this, making those duties optional, rather than required, for Navigator organizations. But HHS has pivoted once again on this, with new rules for 2022 and beyond that once again require Navigator organizations to provide assistance with post-enrollment issues like subsidy reconciliation and eligibility appeals.
Navigators are not permitted to recommend one plan over another or direct consumers towards a particular policy. Instead, their job is to provide general information that consumers can use to understand what’s available to them. Navigators are paid by state and federal grant programs, and they cannot be compensated by the insurance companies.
Certified application counselors (CACs)
Certified application counselors (CACs) can also provide assistance with the enrollment process. They are similar to Navigators, but their role is more limited and their focus tends to be strictly on helping people enroll, without the more extensive assistance that some Navigators can provide.
The exchange designates local “CAC organizations” (health centers, faith-based organizations, colleges, etc.) and people who are affiliated with or employed by those organizations are eligible to serve as CACs. Navigators are funded through the exchange, but certified application counselors are not. Funding for the CAC program can come from a variety of state and federal sources though, including existing public health appropriations. And CACs themselves are often volunteering their time to help people enroll in health coverage.
Insurance brokers and agents
Insurance brokers and agents who are certified by the exchanges can also explain plan details and help consumers determine subsidy or Medicaid eligibility, but – and this is a key difference – they can also make plan recommendations based on a client’s particular situation.
Agents and brokers continue to assist their clients after the plan is purchased, helping them sort out questions and problems regarding billing, utilization, claims, and appeals. Brokers and agents also generally carry errors and omissions insurance, and are licensed by their state department of insurance (this is in addition to their certification with the exchange; Navigators and CACs are trained and certified by the exchange, but are not licensed by the state insurance department).
For health insurance purposes, independent agents and brokers are virtually the same thing, although brokers may represent more carriers or offer different types of insurance products.
ACA consumer protections apply to all individual major medical policies, regardless of whether the coverage is sold in the exchange. And the same open enrollment window – November 1 to January 15 in most states – applies regardless of whether the plan is sold in the exchange or outside the exchange.
But the ACA’s premium subsidies and cost-sharing reductions are only available if you buy a plan in the exchange. If you purchase the exact same plan directly from the insurance company (ie, off-exchange), you’ll have to pay full price, there will be no cost-sharing reductions available, and you won’t have an option to claim the premium tax credit when you file your tax return the following year. If you think that you might be subsidy-eligible, the exchange is definitely where you want to shop.
However, if your employer is offering you an Individual Coverage Health Reimbursement Arrangement (ICHRA) benefit and also offering to let you payroll deduct your portion of the premium that isn’t covered by the ICHRA, you’ll need to select an off-exchange plan in order to fully take advantage of your employer’s offer.
If you’re curious about off-exchange health plans, this FAQ offers a more in-depth look at how they’re regulated and the reasons some people choose off-exchange plans.
Should I keep my transitional health plan (grandmothered) for 2022?
If your current health insurance policy is not grandfathered but was in effect prior to 2014, your plan is considered a transitional health plan or “grandmothered policy.” These plans are not fully ACA-compliant, and were purchased between March 23, 2010 – when the ACA was signed into law – and the end of 2013. This page offers a detailed overview of how grandmothered/transitional health plans are regulated and the specific rules that apply in each state.
Transitional health plans can remain in force throughout 2022 if states and insurers allow it
Transitional health plans were initially slated to end in 2014. But extensions have been granted by the federal government every year, allowing these plans to remain in force if the state agrees and if the insurer still wants to renew the plans. The latest extension allows transitional health plans to renew up until October 1, 2022, and remain in force until the end of 2022. (Without another extension, transitional plans will have to be replaced with ACA-compliant plans as of 2023.)
Transitional individual/family health plans still exist in 29 states. (In the remaining states, these plans were either required to terminate or insurers voluntarily terminated them and replaced them with ACA-compliant coverage.)
Carefully consider the new plans available to you before you decide to renew your transitional plan
If you’re enrolled in a transitional plan and your insurer is offering renewal for 2022, you have the option to keep your plan for another year. But it’s definitely in your best interest to carefully compare your plan with the new options that are available in the ACA-compliant market for 2022.
You might find that you’re eligible for premium subsidies, even if that wasn’t the case in the past. This is particularly true if you were previously limited by the “subsidy cliff,” as that has been eliminated for 2021 and 2022.
And the ACA-compliant plans available now are likely to provide more robust coverage – including all of the essential health benefits – than the plan you purchased prior to 2014.
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