FEDERAL HEALTH INSURANCE EXCHANGE 2021 OPEN ENROLLMENT
The Federal Health Insurance Exchange (also known as the Marketplace) Open Enrollment Period runs from November 1, 2020 to December 15, 2020, for coverage starting on January 1, 2021. Similar to previous years, the Centers for Medicare & Medicaid Services (CMS) is taking a strategic and cost-effective approach to inform individuals about Open Enrollment, deliver a smooth enrollment experience, and use consumer feedback to drive ongoing improvements across the Exchange platform. Consumers can visit HealthCare.gov and CuidadodeSalud.gov to preview 2021 plans and prices before Open Enrollment begins.
Key Updates and Enhancements to Healthcare.gov for the 2021 Open Enrollment Period
Ensuring a Better Consumer Experience
The HealthCare.gov experience has been updated this year by providing better integrated help and enhanced resources to guide consumers; by streamlining application questions; and by improving content throughout the entire application and enrollment process to help enrollees better understand information they may need along the way in making informed choices about their coverage. This summer, HealthCare.gov added a new planning resource for consumers to estimate their yearly income. CMS will continue to improve and enhance the application, enrollment, and educational support based on consumer feedback and testing.
HealthCare.gov introduced new resources and application information for consumers who are offered an individual coverage health reimbursement arrangement (HRA) from their employer. These include a guide on how their individual coverage HRA offer could impact their eligibility for tax credits and cost-sharing reductions to help pay for Marketplace health coverage. The application experience provides enhanced content to help consumers when entering relevant information from their employer’s individual coverage HRA notice and to better understand whether they should accept or decline their employer’s HRA offer.
To maximize enrollment opportunities for consumers in the Alaska and Hawaii time zones, individuals will have an additional two hours beyond the 11:59pm PT December 15th deadline to enroll in coverage.
More Agents/Brokers along with Expanded Opportunities through Enhanced Direct Enrollment (EDE)
More agents and brokers have registered this year with the Marketplace to assist consumers in applying and enrolling in 2021 coverage. In addition, more approved private sector partners are offering EDE-capable websites this year. Enhanced Direct Enrollment (EDE) allows CMS to partner with the private sector to provide more avenues for consumers to apply and shop for Exchange coverage. Through the EDE pathway, consumers have the option to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or to contact the Exchange Call Center.
The safety and security of consumer information is our number one priority. Enhanced direct enrollment partners are required to undergo rigorous audits to ensure compliance with strict privacy and security controls prior to being certified to use this new platform. CMS continuously monitors each partner to ensure they remain in compliance with CMS requirements.
For more information, please see Enhanced Direct Enrollment Approved Partners.
Consumer Tools and Support
On October 26, 2020, CMS launched updates to window shopping (the “See plans & prices” page on HealthCare.gov) which allow consumers to preview 2021 plans and prices before Open Enrollment begins. As in previous years, window shopping lets consumers browse plans without logging in, creating an account, or filling out the official application. Starting November 1, consumers can log in to HealthCare.gov and CuidadodeSalud.gov or call 1-800-318-2596 to fill out an application and enroll in a 2021 Exchange health plan.
Consumer Call Center
The Call Center is often the front line of assistance for consumers as they apply for coverage and compare plan options. For the last three consecutive Open Enrollments, the consumer satisfaction rate remained at an all-time high – averaging 90 percent – throughout the entire Open Enrollment Period. In order to help prepare the Call Center representatives to handle high consumer demand, CMS will continue providing extensive training to Call Center staff prior to Open Enrollment and weekly refreshers throughout the Open Enrollment Period.
In addition to the Call Center, local assistance will continue to be available to help consumers with enrollment. This includes local agents and brokers, Certified Application Counselors, and federally-funded Navigators.
Helping Consumers Connect with Agents & Brokers
CMS will continue to partner with the “Help On Demand” service for agents and brokers. This service allows consumers to request that a Marketplace-registered, state-licensed agent or broker in their area contact them directly for help applying and enrolling. Registered agents and brokers are able to set times when they’re available and then reach out to consumers who expressed interest in assistance.
Learn more about Help On Demand services.
Find Local Help
Find Local Help is a tool that allows consumers to search by city and state or ZIP code to see a list of local people and organizations who can help them apply for and enroll in Marketplace coverage. Consumers can search for a specific person or organization by entering their name and can filter the results based on their preferences and services provided. Additionally, consumers can filter agents and brokers by their years of participation on the Federal Health Insurance Exchange.
Premium tax credits will be available in 2021 for individuals who qualify. Consumers can continue to use Exchange coverage and take advantage of its benefits, including premium tax credits. Plans available from insurance companies will continue to reflect reduced copayments, coinsurance, and deductibles for eligible consumers.
Small Business Health Options Program (SHOP)
Similar to previous years, small business employers will be able to enroll directly with an issuer, or with a SHOP-registered agent or broker. HealthCare.gov allows employers to preview available SHOP plans and find an issuer or agent/broker to work with to offer SHOP coverage to their employees. Quality rating information will also be available for SHOP plans.
Open Enrollment Notices
Each year, the Federal Health Insurance Exchange sends notices to consumers who are currently enrolled in a Marketplace plan prior to November 1 about the upcoming Open Enrollment Period. This notice provides consumers with the dates for this year’s Open Enrollment and the importance of returning during this time to update their application and actively re-enroll in a plan for 2021. The notice also provides consumers with customized messaging for their situation, such as if they’re at risk of losing premium tax credits. Consumers receive additional notices from their current issuer with important information about premiums, coverage and benefit changes, and plan availability for 2021.
To see examples of consumer notices, visit: https://marketplace.cms.gov/applications-and-forms/notices.html
Automatic Re-enrollment Process
Similar to previous years, current enrollees who don’t update their application and enroll in a plan by the December 15, 2020 Open Enrollment deadline generally will be automatically enrolled in the same plan or another plan offered by the same issuer that is intended to be similar, and if that is not available, another plan with a different insurance company. Consumers who are currently enrolled are strongly encouraged to come back and update their information, shop, and pick a plan that best suits their health care needs before the deadline. Consumers who miss the deadline to actively re-enroll in a plan of their choice during Open Enrollment will not be able to make any plan changes until the next coverage year unless they qualify for certain Special Enrollment Periods. The Exchange sends a notice alerting consumers who were automatically re-enrolled.
Consumers whose 2020 issuer doesn’t have a plan available to them for 2021 will receive a discontinuation notice from their current issuer by the start of Open Enrollment. Those consumers may also receive a letter from the Exchange notifying them that they have been matched with an alternate plan from a different issuer to help avoid a gap in coverage. These consumers generally will need to pay their premium for January in order for their 2021 coverage to begin. Consumers aren’t under any obligation to stay with the new plan and are encouraged to take action and choose a plan by December 15. Consumers whose issuer isn’t offering their plan in 2021 are eligible for a Special Enrollment Period due to losing coverage and have the opportunity to choose a different plan.
Marketing and Outreach
CMS plans to spend $10 million on marketing and outreach for the upcoming Open Enrollment Period, matching the same level of spending for the past several years. CMS will continue to use similar marketing tactics that focus funding and attention on the most strategic and efficient ways to reach consumers. This year’s outreach and education campaign will target people who are uninsured as well as those planning to reenroll in health plans, with a special focus on young and healthy consumers. CMS has committed resources to proven high impact, low cost digital outreach efforts including short YouTube videos, social media, and mobile and search advertising.
CMS will also continue to use direct response methods including email, text messaging and autodial messages. Targeted email has proven to be the most cost efficient and effective way to reach consumers. As part of this effort, CMS will send most consumers emails throughout each week, with increasing frequency as the December 15 deadline approaches. CMS will also reinforce educational messaging through ongoing text messages and provide reminder calls encouraging consumers to take action before the deadline.
HealthCare.gov Scheduled Maintenance Windows
Every year, CMS establishes scheduled maintenance windows that provide periods of time when CMS and its partners can make updates or resolve issues. Maintenance will only occur within these windows when deemed necessary to provide consumers with a better shopping experience. Consumer access to HealthCare.gov may be limited or restricted when this maintenance is required. Regularly scheduled maintenance will continue to be planned for the lowest-traffic time periods on HealthCare.gov, which are Sunday mornings.
The purpose in scheduling these times is to minimize any consumer disruption. Like other IT systems, these scheduled maintenance windows are how CMS updates and improves our system to run optimally and are the normal course of business.
For more information on the scheduled maintenance times, visit: https://marketplace.cms.gov/technical-assistance-resources/2021-open-enrollment-healthcaregov-maintenance-windows.pdf
HealthCare.gov Waiting Rooms
Similar to previous years, CMS may deploy a “waiting room” for some consumers who are logging in or creating an account on HealthCare.gov if website traffic becomes high enough to impact the consumer experience. The waiting room is one tool CMS utilizes to optimize a consumers’ experience because it allows CMS to control the volume of users on HealthCare.gov resulting in better performance of the website. If they are in a waiting room, consumers will see a message asking them to stay on the page. The waiting room will refresh when a consumer can continue to apply and enroll with a smooth experience.
Weekly Enrollment Snapshots
Similar to previous years, CMS plans to release weekly enrollment snapshots throughout the Open Enrollment Period.
2021 Health Insurance Exchange Premium Landscape Issue Brief
To view the 2021 Health Insurance Exchange Premium Landscape Issue Brief, visit: https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/2021QHPPremiumsChoiceReport.pdf
2021 Plan Landscape Data
For more information on 2021 individual and family health plans available in the Federal Health Insurance Exchange, visit: https://www.healthcare.gov/health-and-dental-plan-datasets-for-researchers-and-issuers/
2021 Health Insurance Exchange Public Use Files
To see the 2021 Health Insurance Exchange Public Use Files, visit: https://www.cms.gov/CCIIO/Resources/Data-Resources/marketplace-puf
2021 Quality Rating System Public Use Files
To see the Plan Year 2021 Quality Rating System Public Use Files, visit: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/ACA-MQI/Quality-Rating-System/QRS-General-Data-Collection
2021 Issuer Participation County Map
To see the 2021 Issuer Participation County Map, visit: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Health-Insurance-Exchange-Coverage-Maps