When is ACA Open Enrollment?

Currently, Open Enrollment runs from November 1 through January 15 in most states using the federal Marketplace. Enrolling by December 15 allows coverage to begin January 1, while enrolling between December 16 and January 15 means your health plan will take effect on February 1. To activate coverage, you must pay your first month’s premium by the deadline. State-based exchanges may have different deadlines, so check your state's Marketplace before enrolling in a health plan.

Can I change my health plan during Open Enrollment?

Yes. During Open Enrollment, you can enroll in a new Marketplace plan, switch plans, renew your current coverage, or make changes to your household coverage. Outside of Open Enrollment, you typically need to qualify for a special enrollment period to change an ACA health plan.

What happens if I miss Open Enrollment?

If you miss the Open Enrollment deadline, you must wait until the next Open Enrollment Period unless you qualify for a special enrollment period. Qualifying events can include losing other health coverage, getting married, having a baby, or an employer’s offer of a new health benefit, like an ICHRA.

Can I enroll in a health insurance policy outside of Open Enrollment?

You can enroll in a health plan outside of Open Enrollment if you’re eligible for a special enrollment period. If you don’t qualify for a special enrollment period, you may qualify for Medicaid or CHIP if you meet the eligibility requirements, or you can purchase short-term health insurance on a private exchange.

Do I have to enroll in individual health insurance to use an ICHRA?

Yes. To use an ICHRA, you must have a qualifying ACA-compliant individual health plan that provides minimum essential coverage (MEC), Medicare Parts A and B together, or Medicare Part C. Short-term health insurance and other limited benefits don't satisfy the individual coverage requirement for an ICHRA. If you have one of these plans, you can switch to a qualified health insurance policy during Open Enrollment so you can participate in your ICHRA benefit.

What is the difference between a Bronze, Silver, Gold, and Platinum health plan?

The main difference between the four metal tiers is how the plan divides costs between the insurer and the planholder. Bronze plans have an actuarial value of about 60%, and Silver has 70%. Gold coverage has an actuarial value of 80%, and Platinum has 90%. In general, higher-tier plans have higher premiums but lower out-of-pocket costs when you receive care.

Which metal tier is best for health insurance?

There isn't a single metal tier that's best for everyone, as consumers have varying healthcare needs. Bronze may work well for someone who wants a lower premium and doesn’t expect to use much healthcare during the plan year. Gold or Platinum might be a better fit for someone who expects higher medical expenses or has a chronic condition. Those searching for a middle-ground policy or needing cost-sharing reductions may find a Silver plan to be the best option.

Does a higher metal tier mean better health insurance?

No. Metal tiers describe how the plan will divide healthcare costs between you and the insurance company. They don't indicate the quality of your healthcare or guarantee a larger provider network. For example, a Bronze plan can provide the same health benefits as a Platinum plan; however, the cost-sharing structure will be different.

Can I use an ICHRA with a Bronze, Silver, Gold, or Platinum plan?

Yes. Employees with an ICHRA only need qualifying individual health insurance coverage to use the benefit, regardless of the plan’s metal tier. However, how the ICHRA and premium tax credits work together depends on your benefit’s affordability. If your ICHRA is affordable (meaning you’re not paying more than 9.96% of your actual income for the lowest-cost Silver plan on a public health exchange), you can't receive your premium tax credit. If it's unaffordable, you can opt out of the ICHRA and collect your tax credits.

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What is an ICHRA?

If you’re looking to supercharge client offerings, ICHRAs are for you. An Individual Coverage HRA, or an ICHRA, is a type of Health Reimbursement Arrangement (HRA) that increases flexibility for employers and employees to better utilize the Individual Marketplace. This employer-funded HRA allows employers of any size or industry to reimburse employees tax-free for qualified medical expenses.

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