Health Insurance Open Enrollment 2021

Open Enrollment for private health insurance for 2021 will be from November 1st, 2020 until January 31st, 2021. You must enroll in a plan by December 31st to begin coverage on January 1st. If you miss Open Enrollment, you will most likely not be able to get a private health insurance plan at any point during 2021 – even from a private broker.

To read more information about subsidized private health insurance plans and the new state-based Exchange called Get Covered New Jersey, you can read the LRRC brochure below.

TIPS

  1. During previous years, Open Enrollment lasted only 45 days. This year, New Jersey has opted for a 3 month Open Enrollment period. However, to begin coverage on January 1st, you must enroll in a plan by December 31st. If you are currently receiving coverage through the federal Marketplace, look out for a letter from Get Covered New Jersey with application and enrollment information, which you can use to create a new user account on GetCovered.NJ.gov. The federal Health Insurance Marketplace will no longer be providing plans for NJ residents.

  2. If you are a dependent under your parent’s private insurance plan and you may require maternity coverage at any point during 2021, you must check if your insurance plan has maternity benefts. If it does not, and you will not be eligible for NJFamilyCare during pregnancy, you must purchase a private insurance plan during Open Enrollment. If you do not enroll during Open Enrollment, you will not be able to purchase an insurance plan to cover your maternity needs until next Open Enrollment – with coverage beginning in 2022.

  3. United Healthcare Community Plan will not have CHOP in its network beginning December 1. If you are currently on NJ FamilyCare and would like easy access to CHOP, you must enroll in a private health insurance plan that includes CHOP in its network during Open Enrollment. If you are income-eligible for NJ FamilyCare, you are not eligible for financial help buying a private health insurance plan, but you may purchase a full-price plan through a broker. Speak to the LRRC to see if you can keep your NJ FamilyCare coverage with private insurance.

  4. Any lawfully present immigrant (those with a green card, many types of visas, etc.) can buy a private health insurance plan through the Marketplace. If household income is low, plan options will be exceptionally affordable. Last week, an LRRC caseworker helped a woman who just got her green card purchase a private Horizon BCBS plan for only $5/month!

  5. If you live in NJ, you will be required to make a payment on your tax return for any month that you do not have health insurance in 2021. Last year, a family with two adults and three dependents and a household income of $200,000 or below who did not have insurance for the whole year were charged a minimum of $2,351 and a maximum of $5,074. This year’s penalty will be similar.

  6. The network and benefits of an insurance plan is not affected by where you purchase it. If you purchase a plan through Get Covered NJ and receive financial assistance, the network and benefits of the plan will be exactly the same as if you purchase the plan directly from the insurance company or from a private insurance broker. If you are eligible for government help, make sure to purchase the plan through the Marketplace.

  7. Horizon BCBS offers a Gold plan with access to some doctors out of New Jersey (not out-of-network coverage, but good provider options). If you think you may need to see doctors that are not in-network with your current insurance at any point during 2021, you must sign up during Open Enrollment.

  8. If you purchase coverage through Get Covered NJ, you will need to file taxes at the end of the year. Your accountant will complete IRS Form 8962 that calculates the amount of premium tax credit help you used in advance during the year; and the amount of tax credit you qualify for based on your final income. If you used more premium tax credit than you qualify for, you’ll pay the difference with your federal taxes. If you used less, you’ll get the difference as a credit. This is called “reconciling.” Cost sharing and NJ Health Plan Savings are not reconciled at the end of the year. That means that if you received more than you were ultimately eligible for, you will not need to pay them back.

  9. When applying for coverage through Get Covered NJ, there is a question, “Did you reconcile previous year subsidies?” Many people are confused by this question. Answer “yes” if you were on the Marketplace in the past and reconciled your premium help on your tax return. Answer “I did not receive subsidies in the previous year” if you were never on the Marketplace before. If you answer “no,” you will not be eligible for any subsidies.

  10. During previous years, Open Enrollment lasted only 45 days. This year, Open Enrollment has been extended until January 31. You can still enroll in a plan with subsidies until the end of January, for a February 1 effective date. After January, unless you have a qualifying event, you will not be able to sign up for or switch plans until next year, even through a private broker.

  11. A pre-existing condition will not keep you from getting health coverage. An insurance company can’t turn you down or charge you more because of your condition. Once you have insurance, the plan can’t refuse to cover treatment for pre-existing conditions.

  12. Open Enrollment for 2021 coverage ends January 31. If you will need private health insurance coverage at any point during 2021, you must enroll before January 31. There are very few situations that will allow you to enroll in coverage outside of Open Enrollment. These situations include losing job-based coverage, getting married, or moving to a different coverage area.

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