Open enrollment for people who buy their own health insurance starts Wednesday and ends Dec. 15 this year. That’s 45 days, six weeks shorter than last year — and only one of the big changes consumers need to consider. The Trump administration has cut back on marketing and funding for navigators to help people through the process.
Here are five important factors to keep in mind if you plan to sign up for 2018 coverage under the Affordable Care Act.
1. The health law has NOT been repealed.
Despite the efforts of President Donald Trump and the Republican-led Congress, the Affordable Care Act is still the law of the land.
That means if you don’t get insurance through your job or a government program, you will still be able to get coverage for a set of comprehensive benefits regardless of whether you have preexisting conditions. It also means that if you meet income eligibility requirements, you will be able to get help from the federal government to afford your premiums, and, possibly, deductibles and other out-of-pocket costs.
Those “cost-sharing reduction” subsidies help hold down out-of-pocket costs for people with incomes under 250 percent of poverty (a little more than $30,000 a year for an individual). They will be available despite Trump’s decision to stop the federal government from reimbursing insurers for the required discounts. Most insurers are making up the difference by raising premiums.
Meanwhile, if you get premium assistance in the form of tax credits, what you pay for coverage is not likely to be much higher, either. That’s because as premiums go up, so do federal premium subsidies. (More about this below.)
2. The requirement for most people to have insurance — and most employers to offer it — is also still in effect.
Under the law, most households that earn enough to owe federal income tax are required either to have health insurance or pay a fine due with their taxes. The fine for not having insurance in 2017 (and 2018) is the greater of $695 or 2.5 percent of the taxpayer’s income. You can claim an exemption from the fine if you demonstrate that you cannot afford insurance offered in your area.
The IRS has said it will start rejecting returns filed in 2018 that do not indicate whether the taxpayer had health insurance.
Larger employers (those with 50 or more full-time workers) are also mostly required to offer coverage to their workers or pay a penalty. That coverage must be comprehensive and affordable.
3. Like your mama said, you better shop around.
While it’s always been important to compare options, this year it’s more crucial than ever.
For starters, you want to shop and pick a plan yourself so that the marketplace doesn’t automatically enroll you for 2018 coverage. That’s because the auto-renewal date this year is expected to be Dec. 16, the day after the open-enrollment period ends. So, if you are assigned a plan you don’t like, you won’t be able to change it until the 2019 open-enrollment season.
Shopping allows you to compare plans, including which doctors and hospitals are in-network, as well as premiums and copayments, which can vary.
4. Cost will be a factor.
This year, premiums are going up, in some areas by double digits, due in part to the Trump administration’s mid-October decision to cut off cost-sharing subsidies to insurers.
But the premium increases may not affect all plans and “metal levels” — which is why you should compare prices.
Some states, for example, instructed insurers to load those additional costs only onto the “silver-level” plans, which are midlevel plans that cover about 70 percent of an average person’s medical costs. The policyholder picks up the rest of the cost in deductibles and copayments. As a result of the state’s pricing decisions, though, “gold-level” plans, which cover an average of 80 percent of costs, might in some cases have lower premiums than silver plans.
Of course, if you get a cost-sharing reduction — meaning lower copayments and deductibles — because your individual income is below $30,150, you will need to stay in a silver plan.
Another factor to consider, however, is that the increased prices for silver plans may drive up a different subsidy — the tax credits that help people pay premiums. Those remain in place for people earning up to 400 percent of the federal poverty level. They could rise because they are tied to the cost of a benchmark silver plan in each region.
In some cases, the tax credit increase could be enough to make a “bronze” or gold plan have a very low or even zero monthly premium, according to a Congressional Budget Office analysis done before the administration took action. But, of course, consumers not getting either type of subsidy could be looking at higher costs. That gives them all the more reason to comparison-shop.
Some experts suggest looking beyond the official federal and state marketplaces — whether directly checking out an insurer’s website, working through a broker or consulting a private online website — because some states ordered insurers to load additional costs resulting from the Trump order only onto marketplace plans. Therefore, plans off the marketplace might cost less.
5. Buyers should also beware.
Outside of the official marketplaces there may be more insurers selling lower-cost, “short-term policies.”
Sabrina Corlette, who studies the marketplace for Georgetown University’s Health Policy Institute, said that such plans, while less expensive, may not cover all benefits and might exclude coverage of preexisting conditions.
Those plans also don’t meet ACA requirements for “minimum essential coverage,” so policyholders would still be liable for paying a tax penalty. “There are going to be some folks out there taking advantage of consumer confusion,” warned Corlette, adding that shoppers who buy outside of state or federal marketplaces “should go to a reputable broker.”
–Julie Rovner and Julie Appleby Kaiser Health News
Just got my notice from cigna. It’s going from 777.00 a month to 934.00 a month. So much for affordable care act!
Five things to know about Obama Care
1) Obama lied to get it passed.
2) Forcing providers to sell policies to people by definition is not insurance.
3) Making others pay for your care is welfare (yes sometimes help is needed).
4) You cannot through millions more people into a healthcare system without building the infrastructure first and think you will get the same quality of care or think the system can survive.
5) Oh and don’t forget Obama lied to get it passed.
Percy's mother says
2 things you should know:
1. Premiums were going up anyway, regardless of Trump . . . but Trump will get the blame, not the original Affordable Care Act (Obamacare) which was flawed from the beginning, and is still flawed. The reason Trump was working to change Obamacare is because the premium increases are unsustainable for most people buying their own health insurance.
2. Regarding the tax penalties, this is something inherent (written into) the original Affordable Care Act. Most people cheering for Obamacare had no idea they would be penalized with a tax penalty if they didn’t buy health insurance (not to be equated with health care).
Please also take note: Health “insurance” does not equal health CARE.
Chris A Pickett says
Things to know about Obummer care.
1. You were lied to.
2. It’s Not about getting you healthcare, it’s about lobbyist for insurance companies getting more money for them.
3. People like Mt Gruber thinks you are stupid.(if you don’t know who Mr Gruber is, look him up.
4.You were lied to again.
5. If you buy this insurance, you will pay more when you go to the Dr, called co-pays, also you must meet your deductible.
6. Did I mention Obama flat out lied(see if you like your dr. you can keep your dr)
7. Obama lied, you can’t keep your dr.
8. It will save the average family 2500.00 a year, Again Obama lied.
So the Moral to the story is Obama LIED BIG TIME. But we should have known that, he is a politician and his lips were moving.
Do you get to keep your doctor?
I don’t care about “5 things you should know” – here’s one thing I DO know; I would never spend a DIME on anything with that worthless bum’s name attached to it.
To Dennis; I used to pay $1,000 a month in my heath insurance 13 years ago, when I was blessed to become 65 and get my Medicare. So if you were paying till now $777 only was thanks to Obamacare and if just under Trump you received a $200 increase blame it to whoever is POTUS now and not to the one before and stop the brainwash to the believers that have given us all, this communist Tyrant in the WH.
Many millions including hard working Americans that struggle to pay their bills month to month on minimum salaries and no health benefits thanks to the greedy almighty rich corporations have medical until now. This very wealthy corps. that want now more tax breaks under yours and the other above, beloved POTUS while taking away benefits of many millions of those non wealthy Americans that were able to have Obamacare that works for them and afford them to go to the doctor and prevent a worst medical issue to drive them to the ER with sometimes with fatal illness. ER that anyway we all had to pay for them before Obamacare, even if many of our fellow Americans will die for lack of proper medical treatment. Back then 14 years ago in my small business an employee that contributed to our small business health insurance his 50% premium cost the best we could do, run into financial problems when he lost his other part time work and our business paid his other 50% contribution to help him with his situation while needing surgery and recovery…this is how bad was back the lack of Obamacare then …and your POTUS and you all want to go back to that now..to give away more of our hard earned taxes to wealthy..?
Thanks palmcoaster. . . right on! “Everything” that happens with our health care now is all on trump and the Republicans. . . who are doing all they can to “kill” the ACA, no matter what that does to the costs and quality of our health care!
Where is the trump/Republican plan that was “promised” to cover ALL Americans with LOWER insurance premiums and BETTER services???? They had 7 years to create a better system! Where is it????
Regarding the rising insurance premiums under the ACA. The FACTS are that premiums rose at a slower/lower rate once the ACA was implemented. . . this from “Time”:
These increased costs for employers and employees alike may seem steep—up around 50% over the past eight years—but they could have risen far higher had the Affordable Care Act never passed. The Kaiser study shows that average family premiums rose 20% from 2011 to 2016. That rate of increase is actually much lower than the previous five years (up 31% from 2006 to 2011) and the five years before that (up 63% from 2001 to 2006).
Pointing to data from Kaiser, a White House press release recently stated, “The average premium for a family with employer coverage is now almost $3,600 lower than if premium growth since 2010 had matched the decade preceding the Affordable Care Act.”
First of all the past POTUS name given to his proposed Health Care was by you also bigot GOP Reps. Probably you would love it instead to be TRUMPCARE to memorialize the first communist traitor we have in power now?