The Affordable Care Act lives on, and with split government control, it’s safe from the legislative branch of government at least until January, 2021 (though there is an active effort to kill it in the courts, yet again). Despite a need for some bi-partisan cooperation to enhance (and end the sabotage) of the ACA, it is still meeting its original intent – expanded access to health insurance, pre-existing condition coverage for all, essential health benefit coverage, and subsidized costs through state exchanges and Medicaid expansion to help pay for those who cannot afford it.
What’s New for the Affordable Care Act in 2020?
Last year, the citizens of 3 Republican-majority states (ID, NE, UT) bypassed their state governments by overwhelmingly voting for ACA Medicaid expansion with statewide ballot proposals in the mid-term elections. That brings the total number of states with Medicaid expansion up to 36 (+DC). Unfortunately, officials in the 3 ballot-approved states are dragging their feet on the expansion and launch dates are uncertain.
There will be 20 more insurers offering plans next year in the federal marketplace, which is used by people in 38 states, bringing the total to 175. That will be the largest number of issuers since 2016.
As for ACA exchange plan prices, the current administration reported that prices in 2020 will decrease by 4% versus 2019.
Nine out 10 Americans who enrolled in a healthcare.gov plan received subsidies last year, and most Americans will be able to find plans with subsidized monthly premiums of less than $75 (over a third paid less than $10 per month last year). The subsidy threshold for 2020 is based on a multiplier of 4X the federal poverty levels for 2019, with the upper income threshold at $49,960 for an individual, $67,640 for a couple, and $103,000 for a family of four.
Additionally, cost-sharing reductions (aka “CSR’s”) are available to reduce the out-of-pocket costs for eligible enrollees. Once reduced out-of-pocket maximums are met, costs are covered 100%. CSR’s are available on noted “silver” plans only. As of earlier this year, there were 5.5 million enrollees (more than half) that received CSR’s.
Open enrollment for the 2020 ACA plans is live at healthcare.gov, as of November 1. I’ve provided resources and answers to a number of common questions about ACA enrollment below.
If you want to help those who don’t have employer-sponsored health insurance plans, please spread the word to as many people as you can (share this article!). This is very important, because of…
ACA Sabotage: the Short List
As part of current ongoing efforts by the current administration to sabotage the ACA by driving down enrollment, they have:
- Cut marketplace enrollment time in half by moving up the final enrollment date to December 15, versus January 31, as it used to be.
- Slashed marketing and outreach funds by 90% to $10 million, down from $100 million.
- Cut grants provided to “navigators” who educate, guide, and enroll consumers in plans by 84%.
- Repealed the individual mandate, driving down incentive for healthy individuals to register, which can raise costs for those who do.
- Expanded access to junk “short term” plans, association health plans and health sharing ministries – which will drive healthy people out of marketplace exchange plans and in to risky junk plans, while raising the costs for those remaining.
- Instructed Department of Health and Human Services regional directors to not help states with enrollment as they have in years past (in fact, this is their job).
And that’s just the short list. All of this sabotage is meant to increase uncertainty in the insurance markets and reduce the number of healthy, younger individuals who sign up for plans through the exchange. Healthy individuals are needed to reduce the risk pool and lower premiums for everyone. Without them, everyone’s prices will go up.
Why sabotage then, you may ask? There’s no real reason other than politics and spite, with a total disregard for real people being hurt. People with incomes too high to qualify for the credits will bear the brunt of higher premiums (in addition to taxpayers and future generations with increased deficits).
But DESPITE all this, prices in 2020 are still slated to go down. And they would have gone down much more without the sabotage. Most Americans will still be able to find a 2020 ACA marketplace plan for less than $100 with subsidies factored in. This points to the resiliency and continued potential of the program.
What Does the ACA Cover?
Aside from pre-existing condition coverage and coverage of a certain percentage of your total health care costs (up to 100%) once your deductible is met, and 100% once your out-of-pocket maximum is met, ACA plans all cover the following 10 essential health benefits at any time:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
What are the Open Enrollment Dates?
For the 39 states that use the federal healthcare.gov site, plus CT, ID, MD, NV, VT, WA, open enrollment is Nov. 1 – Dec. 15, 2019. Six states (+DC) have their own exchanges and longer open enrollment periods. They are as follows:
|State:||Jan. 1, 2020 Effective Deadline:||Feb. 1, 2020 Effective Deadline:|
|California:||10/15/19 - 12/15/19||12/16/19 - 1/31/20|
|Colorado:||11/1/19 - 12/15/19||12/16/19 - 1/15/20|
|Massachusetts:||11/1/19 - 12/23/19||12/24/19 - 1/23/20|
|Minnesota:||11/1/19 - 12/23/19||-|
|New York:||11/1/19 - 1/31/20||-|
|Rhode Island:||11/1/19 - 12/31/19||-|
|Washington DC:||11/1/19 - 12/15/19||12/16/19 - 1/15/20|
It’s also worth noting that you may be eligible for a special enrollment period with a qualifying life event. There are a number of insurance options for newly uninsured individuals, including ACA plans, outside of the open enrollment period.
Where do I Enroll?
Healthcare.gov. If you’re in one of the states (+DC) with its own marketplace, you will be redirected from there.
If I Currently Have a Plan, Do I Need to Sign Up Again?
If you currently have a plan, it is strongly recommended that you log in to review your options for next year and either renew or switch plans. Significant changes in plans are expected with all of the chaos surrounding the markets (insurers don’t like chaos). Additionally, premium subsidies may change based off of your income and the plans you choose. You will want to update your income and household information appropriately.
Who Should Sign Up for a Marketplace Plan?
Everyone who does not have employer sponsored insurance (either directly or through a family member, including your parents, if you are under age 26), Medicaid, CHIP, or Medicare.
Why Should I Sign Up for a Marketplace Plan?
Because your health and financial solvency is at stake. Even the healthiest among us are just one unforeseen event or imperfect gene away from medical costs that could bankrupt us. Additionally, marketplace plans provide subsidies to roughly 90% of everyone who purchases a plan on the exchanges. If you buy insurance outside of the exchanges, you will not receive subsidies.
What do I Need to Sign up for a Plan?
The Centers for Medicare and Medicaid Services (CMS) has put out a checklist of the information needed for marketplace applications.
Where Can I Get Help Signing up for a Plan, if Needed?
If you have questions about signing up or want to talk through your options with a trained professional, call 1-800-318-2596 or visit https://localhelp.healthcare.gov/#/.
Let’s get everyone enrolled at healthcare.gov!