TABLE OF CONTENTS

What You Should Know About Health Insurance Open Enrollment

  • Start with Healthcare.gov: Whether you’re looking for marketplace coverage, Medicaid, or the Children’s Health Insurance Program, your application on Healthcare.gov will direct you to the right program.
  • Open enrollment ends January 15: Sign up by December 15 for plans that start January 1. The last day to enroll for 2022 coverage is January 15, with coverage starting February 1.
  • Expanded tax credit: If your income was too high to qualify for a tax credit in previous years, check again this year. You may qualify for a subsidy that can reduce your monthly premium.

What’s New in 2022?

This year has seen several changes in the Affordable Care Act that many people may not be aware of that might positively affect their eligibility for affordable coverage.

  • For plan years 2021 and 2022, the American Recovery Plan Act removed the previous “subsidy cliff” and allowed households earning more than 400% of the federal poverty level (currently set at $12,880) to qualify for health coverage through the marketplace for no more than 8.5% of annual household income.
  • Families whose income previously disqualified them for tax credits to assist with health insurance premiums can now get those subsidies, opening affordable care up to millions more Americans than in past years.

Do You Qualify for Assistance?

See the income guidelines for Medicaid, cost-sharing reduction subsidies, and the premium tax credit.

Income Guidelines for the 48 Contiguous States and Washington, D.C.
Persons in household 100% FPL: (minimum to qualify for ACA assistance) 138% FPL: Medicaid cap (in states that expanded) 250% FPL: CSR subsidies cap 400% FPL: premium tax credit cap
1 $13, 590 $18,754 $33, 975 $54, 360
2 $18,310 $25,268 $45,775 $73,240
3 $23,030 $31,781 $57, 575 $92,120
4 $27,750 $38,295 $69,375 $111,000
5 $32,470 $44,809 $81,175 $129,880
6 $37,190 $51,322 $92,975 $148,760
7 $41,910 $57,836 $104,775 $167,640
8 $46,630 $64, 349 $116,575 $186,520
For households of more than eight, add $4,720 for each additional person.

NOTE: Alaska and Hawaii use different guidelines (see this link to guidelines published in the Federal Register).

Checklist for Health Insurance Open Enrollment

Here’s how you can prepare to sign up for insurance on Healthcare.gov:

Know your state marketplace
  • State-based Marketplace (SBM): The state is responsible for running the functions of the marketplace and you’ll apply and enroll on a state marketplace website.
  • Federally-facilitated Marketplace (FFM): The U.S. Department of Health and Human Services runs the marketplace functions and you’ll apply for and enroll in coverage through Healthcare.gov.
  • State-based Marketplace-Federal Platform (SBM-FP): These states are responsible for the marketplace functions, but you’ll apply and enroll on Healthcare.gov.

For a full list of states and their specific marketplace function, please refer to KFF State Health Insurance Marketplace Types.
Know your deadlines The Open Enrollment Period for 2022 begins Monday, November 1, 2021, and runs through Saturday, January 15, 2022. If you want your coverage to go into effect on January 1, you need to enroll on or before December 15. Anyone can visit Healthcare.gov to fill out an application and enroll in a 2022 marketplace health plan. After January 15, you will only be able to enroll if you qualify for a Special Enrollment Period.
Find out if your estimated 2022 income is in the range to qualify for a premium tax credit. You must know your expected income for 2022 to apply for marketplace coverage. Calculate your Modified Adjusted Gross Income (MAGI), which is your adjusted gross income on your federal income tax return, plus any excluded foreign-earned income, tax-exempt interest received or accrued during the taxable year and non-taxable Social Security benefits. Do not include Supplemental Security Income, which is different from regular Social Security benefits. Factor in any expected changes for the next year, like raises or changes in your number of dependents to get your expected income for the next year.

Gather your documents

Before you apply, gather all documents that you will need for the enrollment process. You’ll need the following for anyone in your household that you claim on your taxes:

  • Address
  • Social Security numbers
  • Date of birth
  • Gender
  • Name of employer or source of income
  • Immigration status and info
  • Current health coverage

Choosing a Metal Category

For simplicity, plans in the health care marketplace are divided into four metal categories that determine how costs are divided between the insurance company and the insured. These categories don’t have anything to do with the quality of the care you receive, but they determine how much of your health care costs you will be responsible for.

Bronze This plan has the lowest monthly premium but the highest out-of-pocket costs when you receive care. The insurance company pays 60% of your health care costs, and the plan may have high deductibles that you must meet before the plan begins to pay anything at all. This is a good choice for people who want protection in the event of a serious illness or injury but are willing to pay for most routine care out-of-pocket.
Silver This plan has a moderately higher monthly premium than bronze but pays more of the costs for routine care. The insurance company will pay for 70% of your healthcare expenses, leaving you responsible for the remaining 30%. It will still have deductibles that you must meet before the plan begins to pay toward your costs, but these are typically lower than in bronze plans. This is a good choice for those who qualify for cost-sharing reductions or can afford the slightly higher premium for better coverage. Silver is the most commonly selected plan option, and so for that reason, it is the designated benchmark plan for calculating premiums.
Gold The gold plan has a relatively high monthly premium but provides more robust coverage of routine costs at 80%. Deductibles will generally be low, meaning that the plan will start paying sooner than bronze or silver plans. Gold is a good value if you receive a lot of care and are willing to pay a higher monthly premium for better coverage.
Platinum Platinum carries the highest monthly premium of the four options but provides the lowest out-of-pocket cost when you receive care. Under this plan, the insurance company will pay 90% of your expenses, leaving you responsible for just the remaining 10%. Deductibles are very low, making platinum a solid choice if you require extensive care and need almost all health care expenses covered.

Remember that health plans come in many types, including HMOs, PPOs, EPOs, and more. Some of these will allow you to use any doctor you choose, while others may lock you into strict network requirements and possibly even force you to find a new doctor. Determine before you sign up whether your doctor or pharmacy is in your plan’s network and help you make the right choice.

Health Insurance Resources

The go-to resource for information about health insurance is the Health Insurance Marketplace.  This is your one-stop resource for finding, comparing, and purchasing health insurance plans, along with applying for a premium tax credit, Medicaid, or CHIP.

Another option is to use the find help tab at Healthcare.gov  to find a local agent to assist you. Most insurance agents will not charge you anything to enroll you in a plan, so there is no reason not to take advantage of their expertise to help you navigate the process.

Following are other helpful resources housed on Healthcare.gov and others:

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Tammy Burns
Insurance and health care consultant

Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.

Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

author-img
Tammy Burns
Insurance and health care consultant

Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.

Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

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