The Affordable Care Act lives, and despite a need for some bi-partisan cooperation to improve it, it’s working. It’s been reported that 80% of Americans can find a 2018 ACA marketplace plan for less than $75 with subsidies.
Open enrollment for the 2018 ACA plans is now live at healthcare.gov, as of this morning (Nov. 1). I’ve provided resources and answers to a number of common questions about ACA enrollment below.
There are 2 very important things to note this year:
- Open enrollment ends much sooner this year – on December 15 in most states – so if you do not have an employer sponsored plan or Medicare/Medicaid/CHIP, do not delay in signing up. And yes, you should sign up.
- If you want to help others, please spread the word to as many people as you can (share this article!). This is especially important this year, because…
As part of current ongoing efforts by this 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 in prior years.
- 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 about 40%.
- Announced that consumers won’t be able to complete healthcare.gov applications on all but one Sunday morning during the 45-day enrollment period due to system maintenance.
- 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).
- Cut Cost Sharing Reduction (CSR) payments, which were used to directly offset deductibles and co-pays for low income Americans. As a result, insurers in many states have already raised premiums or added surcharges (most by more than 20%). Other insurers will exit the market, reducing consumer choices and competition.
That’s 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. It’s been estimated that the sabotage efforts could reduce enrollment by 1.6 million (13%) Americans. Healthy individuals are needed to reduce the risk pool and lower premiums for everyone. Without them, everyone’s prices will go up.
The sad part is – there is absolutely no benefit to doing any of this. Reducing investment in the program actually increases costs. In regards to cutting CSR payments, for example, the Republican-led Congressional Budget Office (CBO) found that:
- Stopping CSR payments would raise federal budget deficits by $6 billion in 2018 and $194 billion over the next ten years, relative to current law, due to increased costs for the ACA’s premium tax credits for low and moderate-income people to offset their rising premiums.
- Marketplace premiums for “silver-level” plans would rise by 20% on average, in 2018. Premiums for such plans would be 25% higher in 2020 and thereafter, relative to current law.
- Marketplace insurers in some states would withdraw from or not enter the marketplaces in 2018. As a result, the share of the nation’s population living in areas with no marketplace insurers would rise to 5% in 2018, up from less than 0.5% under current law.
- The number of uninsured would rise by 1 million in 2018, relative to current law.
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).
What are the Open Enrollment Dates?
For the 42 states that use the federal healthcare.gov site, open enrollment is Nov. 1 – Dec. 15. Eight states (+DC) have their own exchanges with longer open enrollment periods. They are as follows:
|State:||Start Date:||End Date:|
|California:||November 1, 2017||January 31, 2018|
|Colorado:||November 1, 2017||January 12, 2018|
|Connecticut:||November 1, 2017||December 22, 2017|
|Massachusetts:||November 1, 2017||January 23, 2018|
|Minnesota:||November 1, 2017||January 14, 2018|
|New York:||November 1, 2017||January 31, 2018|
|Rhode Island:||November 1, 2017||December 31, 2017|
|Washington (state):||November 1, 2017||January 15, 2018|
|Washington DC:||November 1, 2017||January 31, 2018|
Where do I Enroll?
Healthcare.gov (if you’re in one of the 8 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 under age 26), Medicaid, CHIP, or Medicare. If you do not, you will receive a minimum uninsured penalty of $695, and the IRS is still enforcing it. And, as noted, 80% of Americans can find a 2018 ACA marketplace plan for less than $75 with subsidies.
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 85% 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.
With the CSR Payment Cuts, Will I Still Get Subsidies?
Yes – as long as you meet the income requirements. Everyone eligible will still receive premium subsidies. The CSR’s were in addition to the subsidies and helped to cover out of pocket costs on co-pays and deductibles. They will also continue because insurance companies are required to pay them by law. In order to compensate for not getting the payments, insurance companies will increase premiums.
The ACA’s premium tax credits are tied to the premiums for silver plans, so the credits would rise with CSR payments ending (which is why it would cause a federal deficit increase). If your estimated income falls between 100% and 400% of the federal poverty level for your household size, you qualify for a premium tax credit.
Here’s a breakdown of how subsidies and CSR’s work, by income-level:
What’s up with Silver Plan Prices this Year?
Due to the aforementioned CSR and other sabotage, silver plans this year have some interesting price dynamics. Charles Gaba from ACAsignups.net, a site dedicated to ACA analysis, has compiled that states are reacting to the sabotage in the following ways:
- In Alaska, Arkansas, Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New York, North Carolina, Oregon, South Dakota, and Tennessee, prices have been hiked on all silver plans. If you don’t qualify for a subsidy and were hoping to buy a silver plan, check out bronze and gold prices, as they might be more competitive.
- In Alabama, California, Connecticut, Florida, Hawaii, Illinois, Idaho, Maine, Maryland, Minnesota, Nevada, Ohio, Pennsylvania, Rhode Island, South Carolina Utah, Virginia, Washington, Wisconsin, and Wyoming, prices are only higher on silver plans in the market places. If you don’t qualify for a subsidy, look up the insurer’s website, and see if they’ll sell you a silver plan directly, as it may be cheaper.
- In Colorado, Delaware, Indiana, Oklahoma, and West Virginia, premiums will be higher across all plans.
- In the District of Columbia, North Dakota, and Vermont, there’s no premium increase to account for the lack of CSR payments, so insurers may pull out of the markets entirely or states may adopt one of the above strategies.
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!