Keenan Blog

Covered California: Health Insurance Exchange Enrollment is Open Now

November 17, 2020

Your health matters. This year, more than ever, it makes sense to have the right plan in place to meet whatever health issues may come at you. Whether you want to improve or maintain what you have, you need the right team behind you. But the apple-a-day strategy alone will not keep the doctor away. Our KeenanDirect resources can assist you with the information to make these important decisions.

In California, the Open Enrollment period is November 1, 2020 through January 31, 2021. However, coverage purchased after December 15, 2020 won’t begin until February 1, 2021 at the earliest. Outside of California, the federal open enrollment ends December 15, 2020.

This past year, California implemented an individual mandate that required health coverage even though the federal mandate was basically eliminated. California residents are required to have health coverage in place, or they will incur a tax penalty. Yes, there are exemptions for individuals based on financial hardship or religious beliefs, as determined by the state’s healthcare exchange, Covered California. It includes the plan to offer subsidies to individuals and families with income at or below 600% of the federal poverty level in an effort to address health insurance affordability issues, as well as other affordability measures, such as additional premium assistance subsidies.

What Happens During Open Enrollment?

The Open Enrollment period lets individuals:

  • renew current individual or family health care plan;
  • choose a new plan through the health exchange; or,
  • purchase a qualified individual/family plan through a private insurer.

What if Someone Misses the Open Enrollment Period?

Open enrollment is generally the only time that people can sign up for a plan, or switch to a different plan, unless they experience one of several qualifying events. A qualifying event triggers a special enrollment period to purchase health insurance outside of the regular annual open enrollment period.

Are Premium Subsidies Still Available?

Premium subsidies increase to keep pace with the cost of the benchmark plan each year and that will continue in 2021. If you buy health insurance from the Covered California exchange, qualifying for a premium tax credit is determined by your income relative to the Federal Poverty Level (FPL). You don’t qualify for a premium tax credit if your income is above 400% of FPL.

Help for individuals through KeenanDirect is free and you can request a no-cost comparison of ACA plans in California.

Consider Ancillary Coverage for Additional Financial Security

Many of us may not be aware of additional types of coverage that may be available to address specific situations that could arise. A patient can incur significant financial vulnerability based on deductibles, co-pays, coverage limitations and network requirements under their existing medical insurance.

Ancillary coverage can be used to supplement existing coverages as well as to help protect those who are in between policies, have very limited existing coverage or are unable to afford general medical insurance. Ancillary insurance helps cover expenses that are not covered under a traditional major medical policy and/or to fill a “gap” created by a high deductible and other policy limits. These expenses can often be a nasty surprise and mount up very quickly.

What Kinds of Coverage Are Available?

Accident insurance is similar in that it provides additional coverage for medical and out-of-pocket expenses resulting from an accidental injury. Such expenses might include emergency treatments, hospital stays, medical exams, transportation and lodging.

Critical illness insurance helps cover costs associated with serious conditions like cancer, heart attack, stroke, organ failure or organ transplant. Coverage can include lab tests, X-rays, surgical and recovery suites, surgical assistants and nurses, blood and other fluids, anesthesia, supportive equipment like crutches and at-home care.

Cancer insurance can help defray the potentially devastating costs associated with this disease. Coverage can include prescriptions, hospital stays and ER visits as well as a wide range of household and living expenses while off work.

Life insurance needs can vary significantly depending on an individual’s or family’s needs. Factors to consider include age, existing financial resources, family obligations and careful planning for the needs of the surviving beneficiary.

Dental and vision insurance can be important, depending on an individual’s health profile. In addition to coverage for routine procedures like regular dental cleanings and eye exams, these visits are valuable as preventive care in catching conditions early that could become more severe (and expensive) later.

Guidelines for Individual Ancillary Coverage

There are many situations where an individual may want or need to purchase ancillary coverage on their own including:

  • Availability of plans with more favorable rates than offered by an employer
  • Unemployment for more than three months
  • Self-employment
  • No longer covered by a parent's health care plan
  • Over the age of 65

As with any important insurance-related decision like this, the first step is to clearly understand the details of any existing health insurance you may have in terms of what is and is not covered, deductible levels, reimbursement limits, etc. Then take a look at factors such as family history, age, lifestyle, occupation and your overall health profile. KeenanDirect can help you determine how basic health insurance and ancillary insurance would fit into your overall health and wellness goals.


About Sam Cole
Sam Cole serves as Vice President of KeenanDirect. He has more than two decades of experience in the California insurance market. He is a Lifetime qualified member of the National Association of Health Underwriter’s (NAHU) Leading Producers Round Table. For free assistance, please contact us at KeenanDirect: www.keenandirect.com or 855-653-3626.