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ACA Open Enrollment: It’s Time to Choose

Average premiums are dipping and penalty for insurance mandate is eliminated

HealthCare.gov website on a computer screen. Text says: 2019 Open Enrollment runs from Nov. 1 to Dec. 15. Are you ready?

Patrick Sison, Associated Press

En español | The Affordable Care Act (ACA) open enrollment period begins today, and some consumers can expect lower premiums and more insurance plans to choose from between now and Dec. 15.

Monthly premiums for the most popular silver plan on the ACA health insurance marketplaces will drop, on average, 1.5 percent for 2019, according to the Centers for Medicare and Medicaid Services (CMS). But premium changes will vary widely across the country — from an average 20 percent increase in North Dakota to an average 26 percent decrease in Tennessee.

The vast majority of consumers who buy insurance on the marketplace are likely to be eligible for federal subsidies to help pay for premiums. Generally, eligibility for financial help is based on how much you earn, where you live and how many people live in your household. For 2019, the income ranges for eligibility are: $12,140 to $48,560 for individuals; $16,460 to $65,840 for a couple; and $20,780 to $83,120 for a family of three. In 2018, 83 percent of marketplace policyholders received premium tax credits, and 51 percent also qualified for cost-sharing subsidies, which help pay for deductibles, copays and other out-of-pocket expenses. 

CMS officials say that there will be 23 more health plans to choose from this year across the country, and that only four states will be served by only one insurer in 2019, compared with 10 states in 2018.

Complicating the choices for consumers this year is the increased access to and duration of short-term policies — also called skinny plans. These policies may have lower premiums than marketplace plans but do not cover many of the basic medical services guaranteed under the ACA. And insurers can charge much higher premiums to older adults based on their age and refuse to sell policies to people with preexisting conditions.


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Experts say the congressional elimination of the penalty for the ACA requirement that most Americans have health insurance may drive more people to skinny plans that don’t meet ACA standards. While the federal penalty for not having coverage has been removed, residents of Massachusetts, New Jersey and the District of Columbia will still be required to have insurance in 2019, and coverage will be mandated in Vermont starting in 2020.

“Short-term policies are not the same thing as marketplace plans and don’t offer comparable protection against the cost of medical care,” says Karen Pollitz, a senior fellow at the Kaiser Family Foundation. 

Short-term plans were originally designed as a stopgap for people who were in between jobs or had lost insurance coverage for other reasons. The previous administration had restricted the duration of these policies to three months, but now consumers can get them for up to a year, and the plans may be renewed for up to three years. Pollitz cautions that it’s up to the insurer to agree to extend a short-term policy, and if someone with such coverage gets sick, the company likely will be unwilling to renew.

Consumers who already have marketplace coverage should have received a letter from their insurer telling them whether their plan is still in effect and what the 2019 premium will be.  If you don’t do anything during open enrollment, the marketplace will automatically re-enroll you in your current plan, or if that plan is no longer available, you will be signed up for the most similar coverage. 

But health insurance experts strongly urge individuals to shop around to see if they can get a better deal.

“It’s more important than ever that consumers shop or they may risk paying more for coverage,” says Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation. 

Consumers can enroll through healthcare.gov or private insurance websites, including individual insurance companies or brokers. Healthcare.gov has a calculator to help you determine if you are eligible for a premium tax credit and the size of the subsidy for which you qualify. 

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