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A New Special Enrollment Period for Health Insurance

A New Special Enrollment Period for health insurance under the Affordable Care Act (ACA) will begin Feb. 15, 2021, and end May 15, 2021. During this special enrollment, you can sign up for a comprehensive health insurance plan that provides basic and major medical coverage. This Special Enrollment Period was created Jan. 28, 2021 specifically for the COVID-19 public health emergency, by executive order of President Biden and allows additional access to purchase comprehensive health insurance coverage.

Here are some answers to questions you may have:

What is the Executive Order Special Enrollment Period?

President Biden issued an Executive Order on Jan. 28, 2021, to reopen the Healthcare Marketplace. This caused the U.S. Department of Health and Human Services to create a Special Enrollment Period beginning Feb. 15, 2021, and running through May 15, 2021 due to the COVID-19 Public health emergency. (A Special Enrollment Period is a period outside of normal open enrollment when you can enroll for comprehensive health insurance plans if they are available in your state. Other special enrollment circumstances include changes in household such as a new marriage or a new baby; changes in residence such as moving to a new zip code).

Do I have to do anything during this Special Enrollment Period?

If you recently enrolled in a health insurance plan during the Open Enrollment Period that ended Dec. 15th and you are happy with that plan, you do not have to do anything during the Special Enrollment Period.

Is there a penalty for not having health insurance?

There's no longer a penalty on your federal income tax return. However, certain states may require you to have health insurance. If you don't have coverage, the state may charge a penalty when you file your state taxes (Florida is not one of those states). Check with your state to see if they offer any exemptions.

Are there any subsidies or tax credits to help pay for health insurance?

You may qualify for a cost-sharing subsidy to help lower out-of-pocket expenses for a premium tax credit that reduces health insurance premiums. Find out if you're eligible these discounts.

How does this fit into the Direct Primary Care model?

Remember, direct primary care is NOT insurance. Direct primary care is a membership that covers your primary care services. As I like to tell prospective patients interested in joining, think of a DPC membership like a gym membership. Your monthly fee covers all of the services that I offer as a primary care physician. If it can be done inside of the four walls of my clinic, it probably is covered (think: exams, office visits, skin biopsies, pap smears, rapid strep testing, urinalysis tests, wart removals). If it has to leave beyond the four walls of my clinic (think: pathology examinations, lab work, radiology imaging, specialist referrals, prescriptions), then it is not covered under the membership fee. This is where insurance coverage would be helpful.

I encourage you to learn more this new special enrollment period.

If you would like to know more about the benefits of Direct Primary Care even if you still have insurance, schedule a meet and greet and let me explain how.

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