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En español | Open enrollment for the Affordable Care Act health insurance marketplaces begins Friday, Nov. 1. Consumers will have 45 days — until Dec. 15 — to review their coverage and enroll in a plan that best fits their health care needs.
Monthly premiums for the most popular benchmark silver plans are expected to drop, on average, by 4 percent for 2020, according to the Centers for Medicare and Medicaid Services (CMS). But premiums vary widely, depending on where you live and what plan you select. In six states (Delaware, Montana, Nebraska, North Dakota, Oklahoma and Utah), silver plan premiums will decrease on average by 10 percent or more. But in three other states (Indiana, Louisiana and New Jersey) the silver benchmark policies will increase by at least 10 percent. These premium estimates are for the 38 states where consumers use the federal marketplace to get their insurance. Twelve states and the District of Columbia have their own ACA exchanges.
The overwhelming number of consumers who get their insurance through the marketplaces should still expect to be eligible for the federal tax credits that help pay for monthly premiums and for subsidies that can help with such cost-sharing expenses as deductibles and copays. Whether you qualify for financial help depends on your income and how many people live in your household.
For 2020, you are likely eligible for a tax credit for premiums if your annual income falls within these ranges: $12,490 to $49,960 for an individual and $21,330 to $85,320 for a family of three. You can also qualify for a cost-sharing subsidy if your income falls within these ranges: $12,490 to $31,225 for individuals and $21,330 to $53,325 for a family of three. In 2019, 88 percent of ACA enrollees were eligible for premium tax credits. Healthcare.gov has a calculator to help you figure out if you qualify for a tax credit and/or subsidy and the amount you may qualify for.
Six states and the District of Columbia (D.C.) give people longer to apply for 2020 coverage. The extended deadlines are: Minnesota, Dec. 23; Rhode Island, Dec. 31; Colorado, Jan. 15; Massachusetts, Jan. 23; and California, D.C. and New York, Jan. 31.
If you are already enrolled in a plan, you should have received a letter from your insurer telling you whether your plan is still offered, any details of how the plan may have changed and what your 2020 premium will be. If you don't do anything by Dec. 15, you will be automatically reenrolled in your current plan and charged the new premium. If that plan has been discontinued, you'll be placed into the most similar plan available.
"Even if you want to renew your plan and you're happy with it, it's still a good idea go to back to the marketplace, update your information and apply for that plan again,” says Karen Pollitz, senior fellow at the nonpartisan Kaiser Family Foundation. By going back through the process, she says, you can make sure you have the most up-to-date information about the plan and also find out which subsidies you may be eligible for, because the income ranges change each year.
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New this year
For the first time, ACA shoppers will be able to use a government rating system to compare the quality of the plans they are considering. Along with the plan descriptions, CMS will display information from its five-star quality rating system, which gauges how satisfied patients are with a particular health plan and how the plans stack up based on a variety of quality measures.
The ratings are divided into three categories: quality of medical care, the member experience and the administration of the plans.
The scores are based on such factors as how plan members rate the doctors and other providers in a plan's network, the care they've received and the quality of a plan's customer service, including how easy it is to get an appointment, the availability of information, the ability to appeal a coverage decision and other consumer issues.
CMS officials also say they have streamlined the application on healthcare.gov and have updated some of the features on the health care shopping site, including the filters consumers can use to help them better compare plans.
While there is no longer a federal tax penalty for not having health insurance, several states have put penalties on their taxes for those who remain uninsured. In 2019, Massachusetts, New Jersey and the District of Columbia required health insurance, and in 2020, California and Rhode Island will also impose tax penalties for not having coverage.
This year, CMS has increased the number of private websites advertised in the Find Local Help section of healthcare.gov.
"Be careful,” says Pollitz. “These private sites may not show you all of the plans that are available to you, and if it is a site run by an insurance company, it will only show you the marketplace plans they sell.” These sites may also, she says, “suggest or steer you to a product that pays them the highest commission."
Pollitz advises consumers to double back and check with the official healthcare.gov site (where there are no broker commissions) to make sure they have all the information they need to make an informed choice and to see that they've gotten an accurate estimate of the subsidies they may be eligible for.