It’s that time again. In the coming weeks, Americans across the U.S. will be enrolling in health insurance plans to ensure their medical expenses will be covered as they head into the new year. While approximately 82 percent of Americans received insurance through their employer, Medicare, or Medicaid in 2016, seven percent of the population relied on plans purchased on the federal insurance Marketplace as part of the Affordable Care Act (commonly referred to as the ACA or Obamacare).
The ACA is known to go through many changes from year to year, and next year will be no exception. Several changes will go into effect in 2018, from increased premiums to a shorter enrollment period. To help save you from confusion in figuring out what has changed and what hasn’t, we’ve done the research for you. Below, we’ve compiled everything you need to know about enrolling in an ACA-certified plan before the December 15, 2017 deadline.
What is the Affordable Care Act?
The ACA is a comprehensive health care reform law enacted in 2010 by President Barrack Obama. It was designed to make health care more affordable and accessible, as well as expand the Medicaid program that covers adults with incomes below a certain threshold.
ACA-certified insurance plans are purchased through the federal Health Insurance Marketplace, a state-run Marketplace, a broker, or directly from an insurer. These plans are for those who do not have health insurance coverage through Medicare, Medicaid, or another entity such as your employer or the U.S. Military (TRICARE). Like other health insurance plans, Marketplace plans cover the following:
- Essential health benefits such as doctor’s services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more.
- Pre-existing conditions like asthma, diabetes, or cancer that you were diagnosed with prior to enrolling for the health coverage.
- Preventative services such as shots and screening tests.
The ACA also introduced the individual mandate, the requirement that all U.S. citizens purchase health insurance or else face a penalty when filing tax returns. However, in 2016, nine percent of the American population was still without health insurance.
2018 ACA Open Enrollment Period
Perhaps one of the biggest changes in 2018, the open enrollment period for ACA health insurance plans now only runs from November 1 through December 15, 2017—half as long as last year. Plans will take effect on January 1, 2018, if premiums have been paid. This applies for anyone wishing to purchase an individual health plan through the federal Marketplace, a broker, or directly from an insurer.
While most people use the federal Marketplace to enroll in health coverage, those living in states with their own state-specific marketplace will purchase health insurance through their state’s website. These states have the option to extend the enrollment deadline, so make sure to check the deadline for your state of residence. Healthcare.gov provides information on which states have their own marketplace for enrolling in individual/family or small business health coverage through the ACA.
The open enrollment period is the only time to select or make changes to your health insurance plan for 2018, so make sure to get a head start on enrollment. The only exception is for those who have qualifying life events that allow them to change their health coverage during a special enrollment period.
Special Enrollment Periods
Special Enrollment Periods allow those with qualifying life events to enroll in health coverage outside of the specific open enrollment period. Qualifying life events include:
- Loss of health insurance, whether it’s from losing a job or no longer being eligible for your current health coverage.
- Changes in household such as marriage, birth, adoption, foster care placement, divorce, legal separation, or death.
- Changes in residence such as moving to a new ZIP code or county, moving to the U.S. from a foreign country, students moving to/from the place they attend school, a seasonal worker moving to/from the place they live and work, and moving to/from a shelter or other transitional housing.
- Other circumstances such as changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP), gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act Corporation shareholder, becoming a U.S. citizen, leaving incarceration, or starting or ending AmeriCorps VISTA service.
ACA Changes for 2018
There are several changes taking place for the 2018 open enrollment period. However, current ACA plan holders will notice that much is still the same.
Consumers will still be able to enroll through the HealthCare.gov or their state Marketplace. Qualifying individuals are still eligible to receive federal subsidies to help lower insurance premiums that reduce co-pays and deductibles. Shoppers will also still be able to compare coverage options, which will be especially important when taking account changes during the shorter open enrollment period.
Increased Premiums for Silver Health Plans
One of the most popular options on the Marketplace, Silver Health Plans, will see higher premiums in 2018, increasing by as much as 37 percent on average. How much your premium will increase depends on where you live. For example, Alaskan residents will see premiums drop by 22 percent, while Iowa residents will see premiums increase by as much as 88 percent. Which policy you select will also have an impact on your premium, with lower-tier plans seeing smaller increases in premium rates.
How Subsidies Impact Insurance Premiums
These premium increases are in response to the government’s decision to end federal support for the ACA’s cost-sharing subsidies, which reduce deductibles and co-pays for lower-income Americans. When the government decreases subsidies, insurance companies raise premiums to compensate. However, many consumers will not be impacted by the hikes in premium rates because insurers are still required to provide reduced premiums to lower-income families.
For those who qualify, premium subsidies will still limit monthly premium costs to less than 10 percent of their household income. Unfortunately, those who don’t qualify for the premium subsidies (those earning more than $48,000 as an individual or $98,500 for a family of four), may feel the full brunt of the premium rate increases in 2018.
Gold Health Plans Are More Affordable
While the average premium for Gold Health Plans will rise by 19 percent in 2018, many policies in this category will have lower rates than the least expensive Silver Health Plans once subsidies are taken into account. Gold Health Plans usually have higher monthly premiums, but offer lower costs and co-pays when you receive medical care. These plans may be more attractive for consumers in 2018 due to the average deductible of $1,320, compared to a more than $4,000 deductible on silver policies.
New Bronze Health Plans
The government recently authorized insurers to sell Bronze Health Plans that cover less of consumers’ medical expenses. These plans will have lower monthly premiums, but extremely high deductibles and out-of-pocket costs.
Consumers can now also purchase these high-deductible plans with a health savings account in states participating in the federal Marketplace. The health savings account allows you to set aside money on a pre-tax basis and use it to pay for medical expenses before you reach the high deductible and other out-of-pocket costs associated with bronze plans. This allows you to reduce your overall health care costs.
Fewer Insurer Options
The number of insurance providers offering ACA-certified plans will decrease from 167 to 132 in 2018. In addition, people in eight states, or 29 percent of Marketplace enrollees, will only have one insurance provider to choose from when it comes to picking to a plan. In 2017, only two percent of enrollees were limited in this way. The states with only one insurer option are Alaska, Delaware, Iowa, Mississippi, Nebraska, Oklahoma, South Carolina, and Wyoming.
New “Help On Demand” Feature
HealthCare.gov is making it easier for consumers to connect with insurance agents and brokers for assistance in comparing plans and filling out their application through a new “Help on Demand” service. Agents and brokers can help you shop around and compare plans and premium costs in your state.
More Third-Party Options for Enrolling in ACA Plans
Unlike previous years, health insurance shoppers will now be able to purchase ACA-certified plans through web brokers or insurer websites in 2018. In the past, third-party sites could provide information on the different plans available, but would direct visitors back to HealthCare.gov to determine their financial eligibility and to submit their application. Now, consumers will be able to complete the entire enrollment process through these external pathways.
What Happens If You Skip Enrollment?
Those who forget to re-enroll in 2018 or simply miss the December 15 deadline will automatically be re-enrolled in their current plan from 2017. If their 2017 plan has been discontinued, they will be enrolled in a similar plan. This could potentially hurt consumers whose plans will see drastic premium increases. People who are automatically enrolled in a new plan may not receive the correct coverage for their health care providers or current prescriptions.
This is why it is important to shop around and weigh your options prior to the enrollment deadline. What may have been a cost-effective plan for you in 2017 may not have the same appeal in 2018.
How Your Community Cares Rx Can Save You Money on Medications
Many health insurance plans help cover the cost of prescription medications through copayments or coinsurance. However, for medications, the amount you’re left having to pay can still be pretty hefty. You may even be prescribed medications your insurance won’t cover. This is where your Community Cares Rx Prescription Discount Card can come in handy.
A Prescription Discount Card cannot be used in conjunction with insurance when paying for medications, but it may get you a cheaper price than your insurance can provide. In 2017, the average co-pay for generic medications was $11, and for specialty medications, that cost jumps to $101. The Community Cares Rx discount card can offer savings as high as 20 percent on brand-name medications and 70 percent for generics. You can find out how much your medications will cost when using insurance by calling your insurance provider or visiting their website. You can then compare this to the estimated discount you’ll receive by using your discount card instead.
To ensure you get the lowest price possible at the pharmacy, present the pharmacist with both your insurance card and Community Cares Rx Prescription Discount Card and see which gets you the better rate. Don’t have a card? Download yours for free today!