2021 has already brought big changes but even another one comes from California where open enrollment continues until the 31st of January. California offers the longest open enrollment period in the US, far longer than that of the federal marketplace and has permanently extended the enrollment period for everyone; because, as of 2021, residents of California are expected to have healthcare coverage or face a significant penalty on their tax returns. Even though President Trump has federally abolished the penalty, it is up to the state to decide if they will enforce it or not.

Also, due to the pandemic, healthcare insurance policies have increased their premiums, but most have also expanded their coverage. Some, like Anthem (6%), HealthNet (3.4%), Kaiser (1%), Oscar (7.6%) and Valley (9%) have increased. Others like Blue Shield (-2.4%), Chinese Community Health Plan (-1.3%), LA Care (-4.6%), Molina Healthcare (-3.8%), Sharp Health Plan (-0.5%) and finally, Western Health Advantage (-2.6%) have decreased in their premiums. But with all the healthcare expansions to offer a wide variety of more coverage, at least 88% of Californians have the opportunity to select between 3 major insurance groups. And at least 77% have the ability to choose between 4 or more insurances as well.

Since the ACA (Affordable Care Act) has been in effect, former governor of California, Arnold Schwarzenegger, signed into effect in 2010, an exchange for the state known as Covered California and has been widely successful, due in part to extensive legislation to ensure the marketplace remains stable by removing short term health plans (as of 2019) and prevents sole proprietors from purchasing association health plans. Covered California is also the singular exchange in the US requiring all health plans to be uniform; meaning that within a single metal level, all plans have the same benefits except HSA plans (they have their own standardization).