Open enrollment: Here’s what you need to know

Cal i fornia’s annual health insurance enrollment season for individuals and families kicks off this week against a dramatic backdrop: the hotly contested presidential election; a pandemic raging out of control in much of the U.S.; and, on Nov. 10, a Supreme Court hearing of a case that could end the Affordable Care Act and strand millions without coverage.

The massive unemployment caused by the pandemic has already stripped employer-based health insurance from millions nationwide and induced severe financial anxiety as families struggle to pay rent and buy food.

One question hovering over enrollment for 2021 health plans is whether the large-scale loss of medical coverage will generate a surge of sign-ups, or if more pressing financial worries for many people will push insurance lower down their priority list.

“People have so many things to deal with: They’ve lost jobs, they’ve lost a lot of income, and in California they’re also facing fires. I don’t think health insurance has been top of mind for people,” says Cheryl Fish-Parcham, director of access initiatives at Families USA, a consumer health care advocacy organization.

But Peter Lee, executive director of Covered California, the state’s ACA marketplace, is confident it will match the 40% increase in new sign-ups it had for 2020 coverage.

“It is clear that COVID is on Californians’ minds,” he says. “You cannot have COVID on your mind without also having coverage on your mind.”

A Supreme Court decision on the future of the ACA probably won’t come until well into next year, and it is unlikely to affect your 2021 coverage. “So people should feel confident in looking for a health plan,” says Sara Collins, vice president for health care coverage and access at the Commonwealth Fund.

Open enrollment

If you are 65 or older, you probably qualify for Medicare, the federal program for seniors, which is entirely separate from the ACA exchanges and broader individual market. Open enrollment for the private Medicare Advantage plans and Part D drug plans is also underway and ends Dec. 7. Insurance agents can usually help you with Medicare, and you can get advice by calling 1-800- 434- 0222.

If you are under 65, live in the Golden State and want to buy insurance for you and your family, start with Covered California. You can get federal and state assistance to cover some or all of your premiums, if you meet certain income criteria.

The enrollment period for Covered California, and for the individual market outside the exchange, started Nov. 1 and runs through Jan. 31. In states whose exchanges are operated by the federal government, the enrollment window shuts Dec. 15.

Don’t be left out

If you lost coverage and need it for the month of December this year, you can still get it through Covered California if you sign up by Nov. 30. For regular annual coverage that starts Jan. 1, you must sign up by Dec. 15. If you miss that deadline, you can still get coverage starting Feb. 1 if you enroll by the final Jan. 31 deadline.

Many people leave money on the table because they aren’t aware of the financial assistance or think they earn too much to qualify. But you don’t need to be poor to get aid.

The federal subsidies, which are tax credits typically provided in the form of reduced monthly premiums, are available to individuals with annual income up to about $51,000 and a family of four with income up to nearly $105,000.

California has supplemented the federal aid with state- funded assistance that extends further into the middle class: up to around $76,500 for an individual and $157,000 for a family of four.

State website

If you log on to Covered California’s website, www. coveredca. com, you can check how much financial help you qualify for and compare health plans. Or, an insurance agent or certified enroller can do the legwork work for you — at no charge. You can find one on the website. You can also call Covered California directly at 800-300-1506.

If your income is below 138% of the federal poverty level, you will probably qualify for Medi- Cal, the government insurance program for people of limited means. The Covered California website — or an enroller — will let you know if you do and walk you through signing up. You can also contact your county’s Medi- Cal office. If you don’t qualify for Medi- Cal, your children might, because the income threshold is higher for them.

If you are looking for exchange- sponsored coverage, click the “shop and compare” tab on the Covered California website, which takes you to a screen that asks your age, income, ZIP code and family size and shows the health plans available, their premiums and your aid amount.

The website also provides quality ratings of the participating health plans. And you can check for plans that have your doctors in their networks — though, as the website warns, that information is not always up to date.

Comparison shopping on the website is straightforward, because at each of the four levels of coverage — bronze, silver, gold and platinum — benefits are uniform from insurer to insurer. So once you’ve decided which metal tier is best for you, you only need to think about the price and whether your providers are in the network.

If you have a Covered California health plan already, shop around rather than automatically renew the one you’re in. “The best deal last year is not necessarily the best deal this year,” says Anthony Wright, executive director of Health Access California.

Covered California announced a 0.5% average statewide premium increase last month, but actual rate changes vary across the state and among carriers.