A common misunderstanding is that an individual can enroll in an Affordable Care Act (ACA) plan at any time during 2020.  This is not the case at all. Open Enrollment is scheduled to end on December 15th and ACA compliant plans will not be available again until the next Open Enrollment period from November 1, 2021 to December 15, 2021 for a January 1, 2022 effective date. The exception to next year’s open enrollment period would be a qualifying event, which would create a Special Enrollment Period (SEP). 

Examples of a qualifying event would include:

  • Significant change in income
  • Change in personal status such as marriage, divorce, legal separation, or death of a spouse
  • Birth, adoption or death of a dependent
  • Loss of your employment, or spouse’s employment or dependent’s employment
  • Dependent’s loss of coverage due to age

Any of these events would afford a period of guaranteed issue for an ACA compliant plan if the application was submitted within 60 days of the date of the qualifying event. In addition to qualifying for an ACA compliant plan, the individual will also avoid the penalty.

After Open Enrollment ends on December 15th, the only policies available will either be short-term policies, which range between 1 month and 12 months of coverage, or limited benefit plans. Short-term coverage will not provide benefits for any preexisting condition that existed prior to the effective date of the short-term coverage. Short-term plans are also subject to underwriting review, which means the application could be declined due to health history. Limited benefit or indemnity plans as they are also known typically offer a fixed schedule of benefits for medical services and the insured is responsible for the balance. These plans will have annual maximum benefits and there is never an out-of-pocket maximum assigned to the plans.

Both short-term and limited benefit plans are not ACA compliant and the policyholder will be subject to the personal responsibility penalty. Currently under ACA compliant plans, there is no underwriting, no health questions, no waiting period for preexisting conditions and all plans are guaranteed issue.  

Stateside recommends our clients submit the application before December 15th in order to secure an January 1st effective date or at least before December 10th to avoid the large enrollment surge that is anticipated at the end of Open Enrollment.  In fact, for the last couple of years 50% of Stateside’s applications are submitted during the last 7 days of Open Enrollment.

STATESIDE CAN HELP!

Stateside Insurance Services, since 2003, has focused on providing comprehensive health insurance information, responsive customer service and expert industry knowledge for Texas consumers. Stateside has annually been recognized by health insurance carriers and the Health Insurance Marketplace as a Top Producer in Texas.

Whether the health insurance policy is for an individual, family, small business or supplemental Medicare coverage, Stateside dedicates the time, and our deep industry expertise, to ensure our clients have identified the best health insurance plan for their specific needs. 

Stateside is available to answer any general questions regarding your coverage options, can provide a subsidy determination, and even assist in creating and submitting online applications for ACA compliant plans during an Open Enrollment or throughout Special Enrollment periods. 

Stateside can be contacted either by phone (866) 444-3332 (toll free) or by email at info@texasplans.com. Our Telephone Appointment System can be accessed through:

Phone Appointment Reservation.  
By using the Telephone Appointment System, clients can take advantage of scheduling a health insurance discussion when convenient for their schedule. During Open Enrollment phone appointment availability is expanded to include extended hours and weekends.