Buzz
It’s true—the Affordable Care Act is still in place. If you don't have coverage through your job, you can purchase a plan via the Marketplace (also known as 'Obamacare plans') for $100 a month or even less, starting November 1. This year, however, the sign-up process is a bit trickier, so we’ve compiled a guide with the essential things you need to know.
Should I be concerned about open enrollment?
Open enrollment is the period when anyone can sign up for health insurance, no questions asked. It's open to everyone, get it? The other type of enrollment is called special enrollment, which is available throughout the year in certain circumstances. Life events like marriage or the birth of a baby create a special window for your family to enroll. Losing your coverage or moving can also trigger a special enrollment period—click here to find out more about which life events qualify.
If your insurance comes through your employer, you’ll need to check with your HR department about the enrollment period. (They probably have an open enrollment for employees at this time of year.) Employer-sponsored plans are straightforward: the options are what your employer offers, and the cost is whatever they set. Typically, your employer contributes to the cost, so you’ll pay less out-of-pocket than if you bought a plan independently.
If you’re not satisfied with your employer’s plan, you can shop for alternatives. However, it’s rarely a good deal, though. You’ll typically end up paying full price, since your employer isn't contributing, and you likely won’t qualify for subsidies if you decline their offer.
If you don’t have coverage through your job, or if you want to explore other options, the rest of this guide is for you.
Can’t I just skip this and stick with the same plan as last year?
Technically, yes. But it’s always wise to compare options, and this year, relying on auto-enrollment is especially risky. Here are two major issues to consider:
Your old plan might no longer be available. The system will attempt to enroll you in a similar plan, but it might be quite different from what you had before. For example, your preferred doctor might no longer be in the new plan’s network.
It’ll be too late to change your mind. This year, once auto-enrollment occurs, open enrollment will have already ended. If you’re unhappy with the new plan, you won’t be able to switch.
When is the sign-up period?
Open enrollment typically runs from November 1 to December 15, 2018 across most states. This window is significantly shorter than last year’s, when registration was available until the end of January. Some states offer an extended open enrollment period this year, but all begin on November 1, with the following end dates:
California: January 31
Colorado: January 12
Connecticut: January 22
District of Columbia: January 31
Massachusetts: January 23
Minnesota: January 14
New York: January 31
Rhode Island: December 31
Washington: January 15
Many individuals remain unaware of the new dates, so be sure to spread the word. You can also access shareable info cards with these dates in both English and Spanish here.
So, does that mean any time within that period?
No, it's best to sign up early. There’s typically a rush towards the end of open enrollment, so it’s wise to avoid the last-minute crowd.
If you require free, in-person assistance to enroll, it’s even more critical to act early. Funding for these 'navigator' services has been reduced, and with the shortened enrollment period, they’re likely to be overwhelmed. If you or a family member might need help, schedule an appointment right away. (You can search for local assisters and brokers here. Community organizations will also have their own support programs, so be sure to inquire—your local library could be a helpful starting point.)
A final note: the computer systems used during open enrollment undergo weekly maintenance, typically from midnight to noon on Sundays. If this could affect you, review last year’s downtime schedule. The maintenance times were similar, though occasionally they ended early. In contrast, one Sunday that was supposed to be free of downtime ended up having seven hours of delays. As we said—sign up early.
How much will this cost me?
Here’s the good news! Most people qualify for a significant subsidy when they purchase insurance on the Marketplace (healthcare.gov or the equivalent in your state). The specific rates can vary, but there are two types of subsidies available to help lower your costs. Many people avoid using the exchange or don’t sign up for insurance altogether because they don’t realize they qualify. Here are the two subsidy types:
Advance premium tax credits lower your monthly premium payments. These credits are available for individuals earning between 100 to 400 percent of the federal poverty level. The upper limit for eligibility is a modified adjusted gross income of $48,240 for a single person and $98,400 for a family of four. (Different limits apply for Alaska and Hawaii; click here for the details.) Below is the range for different family sizes:
Cost sharing reductions allow you to purchase a silver plan, but with reduced deductibles and copays compared to a standard silver plan. If your income falls between 100 and 250 percent of the federal poverty level, you’re eligible for these reductions. The income cap for this program is $30,150 for an individual and $61,500 for a family of four. Again, these limits vary for Alaska and Hawaii. Here’s the chart for people living in the continental US:
If your income is below these thresholds, you may be able to get more affordable insurance than you think. Visit healthcare.gov or your state’s equivalent to see how much your premiums would be. Most individuals who qualify pay under $100/month, and in some cases, the insurance can even be free.
Silver Plans Are Complicated This Year
You might recall that the White House made an announcement, then took it back, and then made it again, about whether or not they would...actually, they wouldn’t... provide the CSR payments that make these low-deductible silver plans possible. So, are we all in trouble? Surprisingly... maybe not.
Insurers are legally obligated to offer low-deductible plans, regardless of whether they receive the funding for it or not. (They could choose to exit the market entirely to avoid providing these plans, but so far, that hasn't happened.) The real question now is whether your monthly premium will increase due to this situation.
If you qualify for advance premium tax credits (which most people on the Marketplace do), your monthly payments probably won’t see much of a change since the subsidy will increase to cover the difference.
What if you don’t qualify for these subsidies? Well, what happens next depends on how your state chooses to manage the issue. Charles Gaba at ACASignups.net, who has done a tremendous amount of work on calculations and policy analysis, has provided the lists we reference below:
In Alaska, Arkansas, Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New York, North Carolina, Oregon, South Dakota, and Tennessee, the price of all silver plans has been raised. If you don’t qualify for a subsidy and were planning to purchase a silver plan, it might be worth checking out bronze and gold options instead. Yes, you read that right—gold may actually be cheaper than silver.
In Alabama, California, Connecticut, Florida, Hawaii, Illinois, Idaho, Maine, Maryland, Minnesota, Nevada, Ohio, Pennsylvania, Rhode Island, South Carolina, Utah, Virginia, Washington, Wisconsin, and Wyoming, only silver plans available through the Marketplace have price hikes. If you don’t qualify for a subsidy, consider checking the insurer’s website to see if they offer a cheaper version of the silver plan directly. It could be less expensive than the Marketplace version.
In Colorado, Delaware, Indiana, Oklahoma, and West Virginia, premiums are expected to rise across the board. Sorry about that.
In the District of Columbia, North Dakota, and Vermont, there will be no premium increase due to the absence of CSR payments. In these areas, the burden falls on the insurance companies rather than consumers or the federal government. This is one of the areas where insurers may pull out of the market, but regulators might also reverse their decision and adopt one of the strategies listed above.
So, what’s going on politically?
There’s a lot happening, but for now, it’s irrelevant. There’s a bipartisan bill in progress aiming to restore CSR payments permanently, while a Republican-backed bill would fund the CSRs but also repeal parts of the ACA. Additionally, a tax reform proposal may include components of ACA repeal.
No matter what gets passed, it’s too late to impact your 2018 insurance costs or the benefits you’ll receive. Any changes made by legislation would only take effect in 2019 and beyond. Here’s hoping for the best.
