By Becky Parker, ChHC®, Legislative & Health Reform DirectorThe open enrollment period to buy health insurance through the Marketplace began November 1. Established under the Affordable Care Act (ACA), the Marketplace is for people who don’t have health insurance coverage elsewhere. The timeframe during which individuals can purchase insurance is just 45 days for the 2018 open enrollment season which ends December 15, 20171.After this date, individuals who need Marketplace coverage will not be able to buy it unless they qualify for a special enrollment period (SEP).
The shorter enrollment time frame along with other changes made by the current administration could complicate this year’s open enrollment period. Some of the actions include decreasing the advertising budget for the Marketplace open enrollment, reducing funding for the navigator program, and ending cost-sharing reduction payments. These changes along with the ongoing dialogue from the President and Congress about repealing the individual mandate may keep some individuals from taking action during this open enrollment season.
The ACA is still the law and the requirement to have health insurance or pay a penalty is still in effect. The IRS recently announced they will not accept tax returns where the taxpayer does not address the health coverage requirements of the ACA. Returns will not be accepted until the taxpayer indicates they had coverage, had an exemption or pays the penalty.
Individuals who plan to buy insurance coverage in the Marketplace need to be vigilant, do their homework and complete enrollment in a timely manner. To remain in compliance with the law, below are a few tips for the Marketplace open enrollment.
Subsidized Health Coverage
Individuals and families who buy health insurance through the Marketplace can generally choose from four coverage tiers—bronze, silver, gold, and platinum.People under age 30 can also buy a catastrophic plan.Bronze plans are usually the cheapest while the gold and platinum plans tend to be the most expensive, although many insurance carriers no longer offer platinum plans.
People with a modified adjusted household income between 100 and 400 percent of the federal poverty level (FPL), currently around $12,000 - $48,000 annually for an individual, may qualify for premium tax credits under the ACA to help offset the cost of their health care. Other criteria, such as the offer of employer coverage, also help determine the premium tax credit.The sliding-scale subsidies are based on the cost of the second-cheapest silver plan and reduce the premiums of any plan on the exchange except the catastrophic plan.
The ACA also established a second subsidy program called cost-sharing reductions (CSR). Confusion about these CSRs is wide spread as the administration recently ended these payments to insurance carriers. Individuals who qualify for the CSRs will still get them even though the federal government is no longer making the payments to insurance carriers. The CSRs lower the deductible and out of pocket cost for qualified individuals with a household income between 100 and 250 percent of the FPL as long as a silver plan is chosen.
Premiums have jumped substantially across the country for all plans as insurance carriers raised their rates due to the ending of the cost-sharing reduction payments. Buyers in urban areas, like Dallas, Houston and Austin will see the second-cheapest silver plan rates increase 47 percent, 38 percent and 33 percent, respectively. Rates are also on the rise in other areas. Premiums for the second-cheapest silver plan are going up 21 percent in Abilene, 26 percent each in Midland and Lubbock, and 29 percent in Fort Worth.
The higher premiums will have a negative impact on self-employed individuals and non-Medicare retirees who earn too much to qualify for subsidies. These Texans are facing health insurance expenditures rising at least 10 percent, making even the lowest premium bronze plan considerably higher than last year.
Finding Coverage that Fits
Consumers who need to buy their own health insurance coverage should look around and weigh their options. After the Marketplace closes on December 15, 20171, only individuals who qualify for a SEP can buy health insurance. A SEP is generally triggered by a major life event, such as getting married, divorced, the birth or adoption of a child, a spouse dies, or losing coverage through an employer.
The Healthcare.gov website is a good first step to explore health coverage options. By entering an individual’s age and zip code, rates for each plan level will be displayed. Choosing the option to disclose household income will estimate the premium tax credit and estimated premiums which may lower the cost. The CSR eligible plans are noted with a yellow “Extra savings” box on the website. Enrollment is available online or by phone at (800) 318-2596.
Marsh & McLennan Agency also offers a private exchange to help find the right insurance plan. Simply visit insurememmasouthwest.mymarketlink.com to see coverage options and request an online health insurance quote. Alternatively, call (844) 854-9143 to speak with a licensed benefit counselor, who can provide personalized service to help individuals and families find and enroll in a plan.
1 California, Colorado, Connecticut, the District of Columbia, Massachusetts, Minnesota, New York, Rhode Island and Washington have extended open enrollment periods.Check the state or District website for the deadline which can be as little as one extra day.