2018 Obamacare Open Enrollment

The deadline to enroll in a health insurance plan under the Affordable Care Act ends on December 15, 2017. Do not wait any longer to enroll. Phone lines will be very busy and hold times will be long the closer we get to the deadline. The better option is to enroll online, on your own, which only takes about 15 minutes.

Before the Affordable Care Act (ACA), you could buy a health plan at any time in the private individual and family health insurance market. Today insurers have adopted the same enrollment periods as the health insurance marketplaces to encourage people to find coverage sooner, rather than later. The ACA law created new guidelines to help you:

  • Keep your current health coverage if you like the plan.
  • Allow children under 26 to stay on a parent’s health insurance plan.
  • Find affordable insurance coverage through the new Health Insurance Marketplace.
  • Cover pre-existing conditions.
  • Receive the ten essential health benefits and preventive services

To get financial assistance or avoid the Individual Mandate – cost sharing fee at tax time – you will need to sign up between November 1, 2017, and December 15, 2017. The penalty fee, in 2017, was either 2.5 percent of your income or $695 per adult and $347.50 per child, whichever is the greater amount. Fees rise with inflation and the final 2018 fees have not been finalized in part due to the fact that Congress is trying to repeal the Individual Mandate requirement in the next tax bill.

Whether or not there’s a penalty for being uninsured in 2018 remains to be seen, but what is not an unknown is that facing a medical emergency, without health coverage can be debilitating to your finances and can prevent you from getting the care that you need.

During open enrollment, not only are you able to apply for coverage, but you can switch plans and apply for subsidies to help with premium and out-of-pocket costs.

It is recommended to review your coverage before the end of open enrollment every year to be aware of any changes to the plan, pricing, and verify the auto-renewal of any cost assistance you are currently receiving. Take the time to compare plans and be certain you fully understand the options available.

It is probably fastest and easiest to enroll in a health insurance plan on your own, online; however if you feel that you need a little more assistance enrolling, it’s best to contact a health insurance agent. Health insurance agents can help you enroll in plans directly with insurance companies as well as accessing coverage in the marketplaces. They can explain the plans and find the best value for your specific needs if you are unsure which product is best for your situation. The health insurance marketplaces are available around the clock, online, by phone, or in person.

If you miss the opportunity to enroll, you will need to see whether you qualify for an exemption or look to temporary coverage like Short Term Health Insurance.

Information Needed for Enrollment

Before beginning the enrollment process, make sure you have the following information handy:

  • 2017 tax information for you and your family
  • An estimate of incomes for 2018
  • Family medical history – so you know what kind of plan is necessary to meet your medical needs.
  • Social Security Numbers or other legal immigrant document numbers
  • Employer and income information – pay stubs and W2 forms – for every member of your household who needs coverage
  • Policy numbers for any current health insurance plan
  • Any other important information that might impact your health insurance premium or coverage options.

Signing Up

Determine whether your goal is to simply sign up for private insurance, find out if you qualify for subsidies, or need to apply for Medicaid or CHIP due to lower income status.

Then choose how you want to enroll by either:

  • Shop and enroll online using a private, non-governmental marketplace like HealthNetwork.com,
  • Finding your State’s marketplace website or use Healthcare.gov
  • Calling or meeting with a local insurance agent – dial (800) 219-7214 to speak to a licensed health insurance agent
  • Mailing in a paper application.

Choose a plan and make your first payment to your insurance agent, the insurance company, or online, for your coverage to begin.

When visiting state marketplaces and the healthcare.gov site, you will notice the sign-up and enrollment processes are much the same. Healthcare.gov is the official Health Insurance Marketplace for states that did not set up their own marketplace and it guides you through the following process:

  1. Set up an account and provide basic information.
  2. Fill out the online application with information about you and your family regarding income, household size, and current health coverage information. This helps locate the best options for your needs. If your household files more than one tax return, you may want to call a customer service number before you start an application so a representative can walk you through your application and process it correctly.
  3. Compare options that you qualify for between private insurance plans and free or subsidized coverage through Medicaid and the Children’s Health Insurance Program (CHIP). Marketplaces will let you know if you qualify by determining if your income is less than 138% of the Federal Poverty Level (FPL) and if your state expanded Medicaid to allow you access to these programs. Medicaid and CHIP are offered throughout the year. Ask for an explanation on details of costs and coverage.
  4. Enroll online and decide the most convenient way to pay your premiums to your insurance company. If you or your family qualify for Medicaid or CHIP, a representative will reach out to help you enroll. There are ways to call or chat with representatives along the way.

Quick Facts About Obamacare’s Health Insurance Marketplace

  • Minimum essential coverage is included in all marketplace coverage, most Major Medical Coverage sold outside the marketplace, Medicare, Medicaid, employer-based coverage, and more. It does not include short-term health insurance.
  • To purchase or change plans outside of open enrollment you need to qualify for special enrollment.
  • For 2018 coverage, open enrollment begins November 1st, 2017 and ends December 15, 2017.
  • Most plans offered outside open enrollment do not count as minimum essential coverage and will not protect you from the fee – individual mandate – for not having health insurance. Major Medical plans are an exception.
  • If you have access to employer-based coverage, qualify for Medicaid, Medicare, CHIP, or your income is over 400% of the Federal Poverty Level, you will not qualify for premium and out-of-pocket cost assistance through tax credits or subsidies.
  • As of June 2017, 10.4 million people were enrolled in Obamacare.
  • Marketplace insurance purchased before the 15th of each month starts on the first of the following month after you have paid your premium.
  • If you miss the enrollment deadline, you may be eligible for extended enrollment.
  • Open enrollment dates are subject to change each year.
  • The law allows a short coverage gap exemption of up to three months in a row without coverage each year.
  • In states that use auto-renew, you may be switched to a different plan or level of cost assistance automatically if you do not make a choice.

Employer-Based Coverage

If you are offered coverage through an employer, you will most likely stick with that option because you will not be eligible for cost assistance on the Marketplace. Family members who have access to employer coverage will not get cost assistance either. You may lose any contribution your employer makes to your premiums.

You and your family may qualify for an exemption from the mandate if the employer coverage is considered “unaffordable”, which allows you access to more coverage options and special enrollment periods.

If you are eligible for job-based insurance and considering switching to a marketplace plan, qualifying for lower costs based on your income will depend on one of these three conditions:

  • The job-based insurance does not pay a minimum of 50 percent of your premium.
  • It is unaffordable – costs exceed 9.5 percent of family income for employee only insurance.
  • It does not meet the minimum essential requirements, which must be equivalent to a bronze plan sold on the marketplace.

Medicare Coverage

If you qualify for Medicare, you cannot sign up for Obamacare or any other non-Medicare coverage. Look at Medicare Supplements (Medigap) during Medicare’s open enrollment periods if original Medicare is not enough.

Short-Term Coverage Option

The use of open enrollment dates creates a time each year when Obamacare coverage – qualified health plans with minimum essential coverage – are not available in the health insurance marketplaces. If you find yourself without insurance in-between open enrollment periods and do not qualify for the special enrollment period, you may want to look at short-term health insurance.

Short-term health insurance, or temporary health insurance, has a few drawbacks. It will not help you avoid the Obamacare tax fee for not having coverage. Short-term medical insurance is not minimum essential coverage, and losing it will not qualify you for special enrollment in the health insurance marketplaces. It will also prevent you from qualifying for Consolidated Omnibus Budget Reconciliation Act (COBRA) insurance coverage offered upon termination of employment.

The advantage is that it can be an inexpensive temporary solution for those needing to fill gaps in primary coverage or in between coverage options, individuals traveling out-of-network, people who have missed open enrollment or are exempt from the penalty fee due to lower income levels.

Short-term plans may last anywhere from 30 days to 12 months. Depending on the date the policy ends, some insurers will roll you over into a plan with minimum essential coverage during open enrollment. You can make sure that when one policy ends, it overlaps the effective date of a new plan.

Providing benefits only to help avoid a catastrophic illness or injury, short-term plans are different from Major Medical coverage. In 2014, Major Medical plans had to comply with ACA law and offer the required ten essential benefits, which include more comprehensive coverage for preventive care, physicals, and immunizations, as well as adding the benefits of dental or vision care.

An Important Note:

Sign up for the marketplace ahead of time and make sure your account is up and running smoothly. Leaving the application process to the last minute could result in missing a chance to get cost assistance until next open enrollment.

Do not confuse the enrollment period for private coverage for individuals and families with enrollment periods that correspond to Medicaid, CHIP, Medicare, or Employer plans. You will sign up for coverage at work if you have employer-based coverage, and if you qualify for Medicare, you will sign up during the Medicare enrollment period.

The 2017 Open Enrollment period is here and it is important to ask questions about your current plan and be prepared to enroll, make updates to your information, and change plans if necessary. If you are one of those whose insurance provider is leaving the ACA Marketplace, you should have received a letter regarding the need to look for other coverage in 2017. If you are unsure, go to your state’s marketplace website or healthcare.gov, set up or log in to your account, call their customer service lines, or reach out to a health insurance agent as soon as possible.