2020 was a year fraught with many challenges when it came to health, a year when the importance of the protections and the provisions of the Patient Protection and Affordable Care Act were shown to be more important than ever. Many of the challenges of 2020 have continued in the early months of 2021, but the Health Coverage Team of Foundation Communities has been enthused to witness early and immediate opportunities for Central Texans when it comes to their health coverage.
The first 2021 Health Coverage opportunity is to the benefit of individuals who are without health coverage. While Open Enrollment for Marketplace Plans (those that offer comprehensive coverage and associated care and financial protections) is usually only open from November 1st until December 15th, an extension has been offered that will enable those eligible to sign up for coverage until August 15th!
Normally, to sign up for comprehensive health insurance outside of the Nov 1—Dec 15 Open Enrollment Period, you need a valid, documented “qualifying life event.” These events are strict and specific; some examples include: having a baby, getting married, being released from incarceration, gaining a newly eligible immigration status or involuntarily losing your health coverage (for example, if your job ends with it, your job coverage ends too).
This rare and important opportunity is a huge benefit to those who learn of a diagnosis (such as any kind of cancer, including breast cancer) who would otherwise be unable to sign up without a qualifying event. As strange as it may seem, learning of an expensive medical need or suffering an illness or injury IS NOT a qualifying life event that lets you enroll.
Please note that not everyone is eligible for Marketplace plans, but that there are entities that can assist you with determining if you or other members of your tax household would be eligible. Foundation Communities Health Coverage Program is one such program dedicated to assisting Central Texans with exploring their eligibility and their options. While we can assist ANYONE in the state of Texas, it is always a good idea to see if a more local enrollment assistance organization is available to you—as local assisters can better help you understand the area’s plans and where you can receive care with those plans.
The second 2021 Health Coverage opportunity impacts those who may already be enrolled, or who decided against enrolling in a Marketplace plan during the Nov 1—Dec 15th Open Enrollment Period because the plan costs were too high.
As part of the American Rescue Plan, additional financial assistance has been made available for Marketplace enrollees. Those who are already enrolled can access that additional assistance by re-submitting their 2021 Marketplace applications, accessing a new, additional monthly premium assistance amount and re-enrolling in their same plan to apply that amount going forward in 2021. They will also eventually receive the additional amount on their taxes when they reconcile the months in 2021 before the additional premium assistance was applied. If you are already enrolled in a Marketplace plan and would like help taking this step, contact our program (or your local assister program) today!
For those who considered a Marketplace plan but decided it was too expensive, connect with an assister organization today to get help revisiting your eligibility! Plans may be far more affordable than they were during Open Enrollment and an assister can ensure your 2021 application is being correctly completed to ensure you receive the maximum financial assistance the Marketplace and the American Rescue Plan make available to you and your family.
Arianna Anaya is the program manager for Austin-area nonprofit Foundation Communities’ Prosper Centers Health Coverage Program. Arianna has worked closely with providers and service organizations that serve clients with complex medical needs like cancer and HIV. She has played a key role in the provision of processes and trainings that have enabled her program’s enrollment of more than 5,000 individuals in Marketplace health insurance each Open Enrollment season.