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En español | Spread the word. The Affordable Care Act (ACA) Health Insurance Marketplace is still open for business. If you aren’t covered by your employer or through a government program, it’s time to pick your health insurance plan.
The biggest changes Marketplace consumers will face this year are a shorter open enrollment period and the absence of reminders that it’s time to sign up. You’ll have 45 days to enroll in a Marketplace plan this year — from Nov. 1 to Dec. 15 — compared with the 90 days consumers had last year. And there will be less assistance and outreach to consumers than in previous years. The federal government has cut its 2017 budget for ACA advertising and marketing.
Experts say that attempts by Congress to repeal and replace the ACA have confused some consumers about whether the health insurance marketplace is still up and running.
A new poll by the nonpartisan Kaiser Family Foundation shows that about half of uninsured Americans and individuals who currently buy their own insurance mistakenly believe the Marketplaces are collapsing. “There’s fairly widespread confusion about whether the law has been repealed or modified,” says Karen Pollitz, a senior fellow at the Kaiser foundation.
Pollitz is concerned that people’s natural inclination to wait until the last minute to enroll will mean many won’t have enough time to make an informed decision.
“It’s always crowded in that last week before the deadline,” Pollitz says. “That’s when the website [healthcare.gov] tends to be sluggish, and you can sit on hold waiting for the call center. And it’s harder to get appointments with a navigator,” the people who provide in-person help to enroll, she says.
One message that seems to have gotten through: The ACA requires that nearly all Americans have health insurance or face a fine. The Kaiser poll showed that 71 percent of the public knows that the health insurance mandate is still in effect.
For 2018, the penalty for not having insurance is 2.5 percent of adjusted gross income or $695, whichever is greater. What’s more, beginning with the 2018 tax season, the Internal Revenue Service will not process any return unless the filer discloses whether they have health insurance or an exemption.
Making a decision
If you already have a Marketplace plan, you’ll receive a letter from your insurer telling you whether your plan is still in effect and the amount of the 2018 monthly premium.
On Dec. 15 — unless you have chosen a different plan — the Marketplace will automatically re-enroll you in your current plan. If that plan is no longer available, the Marketplace will enroll you in one that is the most similar. Historically, Pollitz says, about a quarter of marketplace consumers rely on auto-enrollment.
But she cautions against that this year. “A lot of stuff is changing,” she explains. “Premiums are changing. Subsidy amounts are changing. Depending upon where you live, the lineup of insurers may be very different. Your doctor may or may not be in the network.”
In addition, the shorter enrollment period also means that whatever decision you make by Dec. 15, is final. In previous years, if you had second thoughts about your first choice or didn’t realize until you got your first new bill that your premium had increased, you still had a month to select a different plan.
“People still had time to change their minds,” Pollitz says. “That’s not going to be true this year.” If you are unhappy with your initial decision, she says, you won’t be able to change plans until the next open enrollment period in November 2018. That’s unless your circumstances change, such as you move or have a death in the family.
If you are new to the Marketplace, you can go to healthcare.gov and get step-by-step instructions on how to apply. (See: 11 Things You Need to Know About Affordable Care Act Open Enrollment)
According to the Centers for Medicare and Medicaid Services, 85 percent of individuals who bought insurance through the Marketplace were eligible for a premium subsidy in 2016. Roughly 60 percent also qualified for cost-sharing subsidies, which help pay for deductibles, copays and other out-of-pocket expenses. That is not likely to change.
The controversy in Washington over whether the federal government is going to continue making payments to insurers to help defray the costs of the cost-sharing subsidies won’t eliminate them for most people with Marketplace coverage.
That’s because under the ACA, subsidies increase in tandem with premiums. So the higher-than-usual premium increases insurers are charging to make up for the lack of subsidy payments from the government won’t affect most people who receive one or both of the subsidies. The premium increases vary widely from state to state and plan to plan.
But these premium increases will impact those whose incomes are too high for them to qualify for a subsidy. Pollitz suggests that these policyholders shop around for a plan that best suits their needs.