Although there is still a lot of uncertainty about the Affordable Care Act, it remains in force which means that its provisions still stand. Under the Affordable Care Act popularly known as “Obamacare”, all Americans who do not have individual health insurance either through employment, Medicare, Medicaid, Children’s Health Insurance Program (CHIP) or other government insurance programs (e.g. Tricare, VA) must buy a health insurance plan or face a penalty for not doing so.
In addition to that, according to the ACA, signing up for health insurance in the individual marketplace or on the state’s health insurance exchange can only happen during the annual open enrollment period. These provisions are meant to curb the high health insurance costs in the nation as well as prevent situations where healthy people only sign up for insurance when they get sick. Situations such as this are responsible for triggering higher health insurance costs.
When is ACA Open Enrollment For 2018?
The 2018 Open Enrollment period starts on November 1st, 2017 and ends on December 15th, 2017. In total, the enrollment period stretches for 45 days. This is a change from previous open enrollment periods which were 3 months long. It is therefore advisable for individuals and families planning to sign up this year to do so early.
Coverage for plans selected between November 1st and December 15th, 2017 are effective on January 1st, 2018.
As noted, all those who do not have health insurance either under their employers or under the government must buy health insurance during open enrollment. Aside from that, one must sign up for health insurance during this period if;
- He or she is over 26 years old and is no longer on the health insurance plans of parents.
- A person is under 65 years old
- See if one qualifies for tax credits which help in lowering the monthly cost of insurance.
- They live in the United States as a citizen or resident alien.
- They are not incarcerated.
However, it is important to note that those who have employment-based insurance can also buy an insurance plan through the health insurance marketplace. However, they must pay the full cost of the insurance except in situations where the job-based insurance does not meet the required minimum standards (health insurance plans must pay at least 60% of the total cost of medical services). Nonetheless, many job insurance covers meet these minimum requirements.
In addition to that, those who live outside the United States for at least 330 days of the year do not have to sign up for health insurance plans for that 12 month period. Such individuals are also exempt from paying the penalty that is levied on uninsured Americans.
What Individuals/Families Can Do During Open Enrollment
Open enrollment period is the only time of the year that individuals/families can renew their current health insurance plans. It is also the only time of the year that the uninsured can sign up for a new health insurance plan through the state marketplace or through private insurance.
Renewal of plans for those who are already enrolled in a marketplace health insurance plan is normally automatic. However, insurance providers may sometimes change their terms including copayment options, drug coverage, and co-insurance among others. In Florida for example, insurance providers have proposed an average increase of 20-30% in rates within the state for 2018.
Providers who change their plans must send their clients a notice of the intended changes. It is very important for people to read well through the notice and understand what the changes mean for them and/or their families.
(Source: Fox News)
Penalties for not having Insurance
Under the Obamacare, uninsured people face certain penalties. In 2017, uninsured individuals faced penalties of 2.5% of income or $695 per adult depending on which is higher. The maximum penalty was $2,085 per family.
- 2.5% of income or $695 per adult depending on which is higher. Maximum penalty was $2,085 per family.$347.50 per uninsured child in the family
- $347.50 per uninsured child in the family
Subsequently, the government (IRS) collected penalties amounting to $2.8 billion from an estimated 4 million uninsured Americans.
The In 2018, and future years, the tax rate will remain at 2.5% while flat and maximum amounts are subject to adjustments in order to factor in the effects of inflation.
According to Federal law, the government can only collect these penalties by deducting them from an individual’s tax refund.
Exemptions from Mandatory Health Insurance Plans
Individuals who meet certain requirements are not required to sign up for health insurance during open enrollment period. Qualifications for this include;
- If one is uninsured for less than 3 months of the year.
- One is a victim of domestic violence or a man-made or natural disaster.
- One is evicted from the home and/or declared bankrupt.
- One is incarcerated
- One is not a legal resident of the United States
- Membership of a recognized religious group that objects to insurance.
- One loses eligibility for Medicaid because his/her state did not expand Medicaid eligibility under the Affordable Care Act in 2017.
- One has an income that does not meet tax filing requirements.
What about the Special Enrollment Period?
Once the open enrollment period ends, uninsured individuals can only sign up for a new health insurance plan or change the current health insurance marketplace plan if they have a life event that makes them eligible for the Special Enrollment Period. These qualifying events include;
• The loss of health insurance in the past 60 days. One may also qualify for SEP if he or she expects to lose health insurance in the next 60 days. These include losing plans through family members, losing eligibility for Medicare, Medicaid or CHIP, losing employment-based coverage or even losing marketplace insurance coverage.
• Events that have resulted in a change in the household size in the last 60 days. These include getting married, getting or adopting a child and getting divorced or legally separated and losing health insurance as a result. One can also qualify for a SEP if someone within the individual’s marketplace plan dies resulting in a situation where the individual is no longer eligible for the current plan.
• Events that result in a change of residence e.g. moving to a new ZIP code or county, moving to the United States from a foreign country or U.S territory and moving to or from a shelter or other form of transitional housing.
However, one must prove that he or she had qualifying health coverage for at least one day in the 60 day period before making the move. This is not required for individuals moving into the United States from a foreign country or U.S territory.
• Other events such as one getting released from incarceration.
Open Enrollment in Florida
Since the insurance marketplace in Florida is federally run, residents of the state enroll for health insurance plans through Healthcare.gov. In the 2017 open enrollment period in Florida, over 1.7 million people signed up for private plans a 1% increase from 2016. This is the highest enrollment rate in all the states.
Six insurers are expected to sell their coverage plans in the 2018 open enrollment period. These include;
- Florida Blue, which is the only insurer that has sold its plans on the ACA marketplace in Florida since the beginning of Obamacare. Florida Blue was also the only insurer to offer statewide coverage in 2017 and is expected to continue doing so in 2018. Also, the only one that sells plans in all counties.
- Celtic Insurance which is expected to increase coverage in 2018.
- Florida Health Care Plan
- Health First Commercial Plans
- Health Options
- Molina Healthcare
Humana, which was among insurance providers in the 2017 edition of open enrollment, has exited the individual health insurance marketplace nationwide.
Residents of Florida who would like to know more about their options during the 2018 open enrollment are advised to consult with a licensed Florida health insurance agent. The agents are free to use, and the policy prices are the same.
It is also advisable for residents to apply for tax credits as these lower the monthly premium costs of insurance. Out of those who enrolled in health insurance plans through the Florida open enrollment period in 2017, at least 90% of them are receiving tax credits which lower average monthly premiums to $118 down from $442.