Guide to the COVID-19 Marketplace Enrollment

The COVID-19 emergency has manifested unprecedented challenges for Americans as millions of its citizens face uncertainty, financial stress, and new health problems amid concerns in the wake of the global pandemic. What’s more, many Americans are still uninsured or underinsured and are in need of affordable health coverage. 

Last month, HealthCare.gov re-opened for enrollment for 12 weeks in response to the COVID-19 public health emergency. This gives people who were unable to sign up for healthcare coverage during Open Enrollment another chance with this special enrollment period. 

Nearly all state-run marketplaces have also re-opened enrollment to residents.

What are Special Enrollment Periods?

Special Enrollment Periods (SEP) are times outside the Open Enrollment Period when consumers can register for health insurance. Special circumstances include losing a job, having a baby, or getting married. 

Depending on the Special Enrollment period, consumers typically have 60 days before or 60 days following the event to enroll in a plan. 

Enrollment Period Dates

From February 15, 2021, through May 15, 2021, marketplaces that use the healthcare.gov platform will re-open to allow people to sign up for health insurance coverage.

Who is Eligible to Enroll?

Any uninsured U.S. citizen who is at least 18 years old and not incarcerated can enroll in Marketplace health coverage. Also, people who are already enrolled in marketplace plans have the chance to switch policies. This is the same for state health insurance marketplace coverage, but consumers are urged to contact their state-based Marketplace for specific details.

If you have Medicare coverage, you’re not eligible to use the Marketplace to buy a health or dental plan.

Statistics show that 8.9 million uninsured Americans are eligible for marketplace subsidies but not currently enrolled. An additional six million uninsured people are qualified to buy unsubsidized coverage through the Marketplace.  

You are also still eligible to get 2021 health insurance if:

• You are eligible for a Special Enrollment Period due to a life event.

• You are eligible for Medicaid or the Children’s Health Insurance Program (CHIP).

How Do I Sign Up for ACA Coverage During the COVID-19 Special Enrollment Period?

If you are interested in signing up for new coverage during the COVID-19 public health emergency, you should:

• Start an application or log in to update your existing application

• Before you apply, do some research and preview 2021 plans and prices. Check out what Marketplace plans cover. Keep in mind that all Marketplace plan coverage includes treatment for pre-existing health conditions and coverage can't be terminated due to a change in health status, including diagnosis or treatment of COVID-19. 

• If your household income has changed from COVID-19 or you have undergone any other life changes, you may be able to update your plan during the special enrollment period. 

  Log in to your account to update your Marketplace plan.

How many people are enrolling? 

More than 200,000 Americans have already signed up for Marketplace coverage during the special enrollment period due to the COVID-19 pandemic.

The latest figures show that the number of people enrolling in Marketplace coverage was nearly three times higher than during the same period last year, and roughly 3½ times more than in 2019.

The Biden Administration plans to periodically release data on sign-ups during the COVID special enrollment period, with the goal to expand health coverage to as many people as possible during the pandemic.

Affordability of Marketplace Health Programs

A 2020 Kaiser Family Foundation study found that 84% of marketplace enrollees received premium tax credits (PTC) that helped reduce their monthly premium. It also found that 49% received cost-sharing reductions (CSR) that lower deductibles in silver-level plans.

People with income between 100% and 400% of the federal poverty level are eligible to receive premium subsidies to help make the health insurance marketplace more affordable.  

The premium tax credits can be applied at any metal level marketplace plan (bronze, silver, gold, and platinum). In 2021, an estimated 4 million uninsured people are eligible for a zero-cost bronze plan. But, because cost-sharing subsidies are only available through silver plans, there are some serious tradeoffs associated with “free” bronze plans. Bronze plan deductibles, for one, typically push $7,000 per year. On the other hand, silver plan deductibles with a CRS can be as low as $200.

Data shows that 75% of uninsured individuals are not interested in free bronze plans with such high deductibles and that two-thirds of uninsured people cite affordability concerns as the main reason they don’t have coverage.

What Does Marketplace Health Insurance Coverage Cover?

The plans offered during the COVID-19 Special Enrollment Period, and all other times, cover the following ten essential health benefits:

• Outpatient (ambulatory) care.

• Emergency services.

• Hospitalization (including for surgery and overnight stays).

• Pregnancy, maternity, and newborn care.

• Prescription drugs.

• Rehabilitative and habilitative services and devices.

• Mental health and substance use disorder services.

• Behavioral health treatment, counseling, and psychotherapy.

• Lab services.

• Preventive and wellness services.

• Chronic disease management.

• Pediatric wellness, oral, and vision care.

Marketplace Health Coverage

Typically, the federal health insurance Marketplace is only open during the open enrollment period — a six-week period at the end of the year. For the rest of the year, consumers can only secure federal coverage if they get special permission because of a major life change, like losing a job or having a baby. Health insurance sold through federal and state ACA marketplaces is intended for people who can’t get affordable health benefits through a job. Thirty states rely on healthcare.gov, and the rest run their own insurance exchanges.