It's Time to Enroll In or Renew Your Health Care Coverage
2021 Marketplace Open Enrollment: Nov. 1, 2020 to Dec. 15, 2020
Now is the time to think about your health care needs for 2021. Just as your needs change, health plans change too. There are new plan options and new health coverage options being offered for 2021 so it is important to know what has changed and what you need to do during this year's Open Enrollment.
You may have heard that Virginia will be setting up a State Health Benefits Exchange beginning in November 2020, with full implementation by 2023. This is still in the early planning stages and will not affect your Marketplace coverage this year.
There are rules for Virginia’s Medicaid program that may affect your 2021 Marketplace coverage. On January 1, 2019, Virginia Medicaid launched a new health insurance option for adults. Since then, some adults who qualified for financial assistance to purchase a Marketplace plan in previous years may now qualify for full-benefit Medicaid coverage. This includes single adults earning up to $17,609 a year. When you complete or update an application on the Marketplace, an assessment is done for both Medicaid and Marketplace coverage with financial assistance. If you are eligible or likely eligible for Medicaid, your information will be sent from the Marketplace to Virginia and assessed for Medicaid eligibility.
What to do if you already have Marketplace coverage
If you already have a Marketplace account, make sure you can still access your account and, if needed, update your password. Go to healthcare.gov if you need to create or update your account.
Some important elements have not changed for 2021:
One-on-one help is still available! You will have someone who will help you every step of the way. Located throughout the state, application assisters are highly trained and know all about how to enroll in and renew health care coverage. Use the locator to find help in your area. Their services are at no-cost: you do not have to pay for their help!
Financial assistance is still available! 84% of Virginians who enrolled in 2020 Marketplace coverage received financial assistance, which brought their average monthly health care bill down to $94 per month! Some people qualify for help with their bill each month PLUS lower copayments, coinsurance, deductibles, and out of pocket expenses! Use the estimator below to see how much assistance you may receive in 2021.
You have plenty of options – and one place to go to see them all! You can choose from four levels of coverage: Bronze, Silver, Gold and Platinum. You can choose coverage from big name companies like Anthem HealthKeepers, CareFirst, Cigna, Optima, Kaiser Permanente, Piedmont Community Health Plan, and others. View all of your health plan options!
As always, one-on-one help is still available! Application Assisters are available to answer your questions and help you enroll. Click here to find an Assister today!
Click each section below to expand for more information about Marketplace coverage.
You can see all of your health care coverage options in one place! How’s that for easy and convenient? You don’t have to go from site to site. One stop shopping is the way to go!
Before shopping for health care plans, the best thing to do is to think about what type of health care services you will need in 2021. Will you just need an annual physical? Are you thinking about having a baby? Do you have any ongoing condition(s) that will require regular visits to a doctor, lab tests, or prescription drugs? Having an idea of what type and the amount of care you will need will help you choose the plan that is best for you.
Next, take the time to see if you can get financial assistance and how much money that will be. In Virginia, 84% of enrollees got an average of $556/month in financial assistance towards their 2020 coverage. Use the estimator tool as a starting point. Getting this estimate will help you with budgeting for your 2021 health care coverage.
Ready to start shopping?
You can look at plans available to you by shopping on the Marketplace. You will have to type in your age, how much money you think you will make in 2021, your zip code and answer three simple questions. Next, you will be able to see what plans you can choose from and your estimated financial assistance. You will then need to complete a full application to enroll.
Download the 2021 Plan Selection [PDF]document to help walk you through plan choices and costs.
It's Enrollment Time!
Congratulations on making the decision to enroll. Having health care coverage can protect you from high, unexpected medical costs. It can also help you take care of yourself by giving you access to important preventive care screenings and services – at no cost!
The enrollment process may take some time, especially if you are enrolling more than yourself in coverage. Before you begin, it may be helpful to review these [PDF]Enrollment Tips. You can enroll:
Whichever method is right for you, you can always get help from an assister or by calling the Marketplace Call Center (1-800-318-2596; TTY: 1-855-889-4325; 24 hrs/day, 7 days a week)
Information You Need to Enroll
Before you start the actual enrollment process, make sure you have in front of you the following information for each person you are going to enroll:
Social Security Numbers for anyone applying for health insurance
Home address and mailing address, if different
Employer and income information for everyone in your household (W2s, paystubs)
Your best estimate of what your 2021 household income will be
Documentation showing you are a legally residing immigrant (if applicable)
Information about any other health insurance coverage available to anyone in your family, even if they aren’t enrolled in it
Your health plan ID number and insurer's name if you had/have coverage for 2020
A completed [PDF]
Employer Coverage Tool for everyone being enrolled who is eligible for employer-based coverage, even if not enrolled in the coverage
Names of current physicians and prescriptions to help select the best plan for you
Starting the Enrollment Process
The first step in enrolling is to create an account on the Marketplace. You will need to provide your name, a valid email address, create a password and select security questions. Once you have set up your account, you will be able to save your information as you move through the enrollment process. Sometimes it can be helpful to take a break during the enrollment process. Once you have your account set up, you can save the information you have provided and then come back to it later.
When to Start the Enrollment Process
You can set up your account now! Plans and prices are available now! If you activated your account and already know what plan you want, you can start enrolling on November 1!
Coverage Starting January 1, 2021
If you want your coverage to start on January 1, 2021, you can enroll anytime from November 1 through December 15. Here is a tip. Do not wait until December 14 or 15 to enroll! Many people do and the system response time will be slower, the call centers will be busier and your local application assisters may be all booked up. All of these can lead to frustration and frankly, a bad experience. That is not what we want for you. Instead, consider enrolling early, like before Thanksgiving! So be an early bird and rest easy!
No matter when you enroll during open enrollment, your 2021 health care coverage will start January 1, 2021 and will expire at 11:59:59 on December 31, 2021 as long as you continue to pay your monthly premiums.
I Submitted My Application. Now What?
Congratulations! You've taken a big step toward getting covered.
After you submit your application, you will get your Eligibility Determination Notice. This will let you know if you can purchase coverage on the Marketplace, if you qualify for financial assistance, how much and what type of financial assistance you qualify for, and if you do or may qualify for Virginia’s Medicaid program. Each family member’s eligibility may be different, so read it carefully! Your Eligibility Determination Notice will also tell you if the Marketplace needs any more information from you and how to submit it. You can still enroll in a plan if the Marketplace requests more information, but if you do not submit it by the requested date, you may lose your insurance. Read this notice carefully! If you have questions about it call the Marketplace at 1-800-318-2596 or a local assister.
If you qualify to purchase a plan on the Marketplace, you can continue to compare plans and choose one to enroll in! The company whose health plan you chose to enroll in will begin processing your application, but your enrollment will not be complete until you make your first premium payment. When your enrollment information is processed, the company will send you notification that you have to pay the bill for your first month of coverage in order for your coverage to become active. If you do not hear from your insurance company, contact them!
If you qualify for Medicaid, your information will be sent to Virginia for completion of enrollment. Virginia will then send you information regarding your new Medicaid coverage. If the Marketplace was unable to make a final Medicaid decision, your information will be sent to Virginia for them to finish reviewing your application. They may need more information from you, so keep an eye on your mail! You can always call Cover Virginia at 1-855-242-8282 to follow up.
Paying for Your First Month of Coverage
When you first enroll in a plan, you will have to pay the bill for your first month’s coverage fairly soon after you submit your application. The company will notify you of:
How much the bill is
When it is due, and
Where and how you can pay it
Paying this bill for the first month of coverage is the last step in fully enrolling in the plan. If you do not pay that first bill, you will not have health care coverage!
Each month, you will be responsible for paying for your health care coverage for the next month. For example, by June 30 you will have to pay for your health care coverage for July. This monthly fee is called your premium or monthly premium.
Receiving Your Member Identification Cards
Once you have enrolled and paid your first month’s bill, the company will send you more information along with your member identification card(s). You will show these cards each time you seek medical care from your doctor, a specialist, the pharmacy, the lab, etc. It is a good idea to keep your member identification card with you.
Learning How to Use Your Coverage
Now that you have coverage, it’s important to know how to use it so you can get the maximum value out of it! Take a look at this [PDF]booklet. It’s a great guide to using your health care coverage.
Application assisters are available all year to help you understand how to use your coverage, too. Feel free to work with them to learn more about your plan!
Renewing Your Plan - You Have Options!
You might not think you have options when it comes to renewing your coverage, but you do! Did you know when it's time to renew, you can select from any of the plans available in your area?
Plans Change
You do not have to renew the exact same plan you had for 2020. That’s important because plans change. You might have different needs for 2021. If you do, a different health care plan might work better for you. New health plans are offered every year. Return to your account, update your application and see your 2021 options before the end of Open Enrollment.
Starting the Renewal Process
The company offering your current plan and the Marketplace will send you notices that it’s time to renew. The notice from your current company will let you know what your estimated premium for 2021 will be based on last year's information. In addition, sometimes they will stop offering some plans. If they don't offer your plan for 2021, they will list what is called a replacement plan, but you don't have to choose that plan, and it may not be the best fit for you. It’s always a good idea to shop around! You can view all of your options by returning to your healthcare.gov account and completing a 2021 application.
If you do want to change your plan for 2021, you should do so as soon as possible to avoid being auto-enrolled in the old plan before you are signed up with the new plan.
December 15 - A VERY Important Date
You will have to renew your coverage by December 15 if you want a new plan for 2021. Note: If you do not renew online, by phone or in person by December 15, the company offering your current plan will likely auto-renew you in the health plan listed in the notice they sent you. That plan will become your 2021 coverage unless you make a change. Keep in mind that not updating your account and actively looking at plan options may end up costing you hundreds of dollars in 2021 because your level of financial assistance will be based on old information.
Update Your Account and Household Information for 2021
While you are out looking at your health plan options, take the time to update your information on your account. Making sure you update your estimated household size and income for 2021 will put you in the best position for getting the most financial assistance you qualify for. If you qualify for a subsidy, the amount you will receive is based on what's listed in your account as household size and income. Inaccurate information there could lead to the wrong amount of assistance each month. That could mean more money out of your pocket.
What's this auto-renew option?
Auto-renew is a process where the company you are currently enrolled with will re-enroll you in your current plan or a similar one. You do not have to do a thing. If you choose to auto-renew, keep this in mind:
You may not be eligible to be auto-renewed, so read your notices from your health plan and the Marketplace carefully!
Your health needs might have changed and that plan might not be the best for you in 2021.
You might be enrolled in a plan that is not right for you now.
You might not update your online account for 2021. That could mean your financial assistance evaluation will be based on old information. As a result, you could pay more all year than you should.
Yes, auto-renew is easy. But, it could cost you in the long run. Isn’t spending ten minutes now worth keeping hundreds of dollars in your pocket next year?
Renewing Coverage
To renew coverage, you can:
Login to your online account. You can complete a 2021 application, review your 2021 eligibility notice and select a new health plan option. You can also look at what drugs the health plan covers and what doctors are in the network.
Talk with Marketplace Call Center representatives. They will be able to update your account information and read what plans you can choose from. They will not be able to tell you about the drugs covered under each plan or the doctors in the network. The call center number is 1-800-318-2596; TTY: 1-855-889-4325
Work one-on-one with an application assister. Assisters can walk you through the process, show you plan options, drugs covered and doctor networks. They are great to talk with about plan options and any concerns or questions you might have. Plus, there is no cost to you.
Let's Go Shopping!
