Open enrollment, the period where you can sign up for health insurance for the coming year under the Affordable Care Act, runs from Nov. 1 to Dec. 15 in most states. If you don’t enroll…
Open enrollment, the period where you can sign up for health insurance for the coming year under the Affordable Care Act, runs from Nov. 1 to Dec. 15 in most states. If you don’t enroll during that window, you cannot get coverage for 2019 unless you qualify for a special enrollment period, which is allowed after certain life events, including losing health coverage, moving, getting married, having a baby or adopting a child.
That much hasn’t changed about open enrollment. Another constant, unfortunately, is confusion. “About a third of people do not understand open enrollment,” says Paul Rooney, vice president of carrier relations for eHealth, an online marketplace for health insurance plans. They also are stumped by short-term insurance plans, the repeal of the individual mandate provision in the ACA and other changes this year. “We’ve seen confusion for the last few years. This is not necessarily more confusion, just different confusion,” Rooney says.
Varying enrollment periods. Some states have longer open enrollment periods. California, for example, extends open enrollment from Oct. 15, 2018, through Jan. 31, 2019. Check with your state insurance department for the dates, or consult a list of open enrollment dates for all states like the one eHealth has compiled.
No penalty. There is no longer a penalty for going uninsured. The Tax Cuts and Jobs Act of 2017 removed the individual mandate requirement that everyone sign up for health insurance or pay a penalty of $695 per adult or $347.50 per child or 2.5 percent of household income, whichever is greater. As a result, you can choose not to buy health insurance or purchase a plan that is not ACA-compliant without any penalty.
Premium increases are down. Premium increases for 2019 are much lower this year compared to last year. “We are seeing increases in premiums at around 3 to 5 percent this year, versus double-digit increases the past few years,” Rooney says. “There are still some policies with big increases, but we are seeing some stability that we haven’t seen in the past few years.”
Some plans are even lowering premiums, says Karen Pollitz, a senior fellow at the Kaiser Family Foundation. “That’s likely because some of them overshot the mark last year. They were very nervous about the uncertainty around ‘repeal and replace,’ so they built huge uncertainty factors into 2018 premiums. In some cases they are starting to roll that back a bit.” In addition, companies that hadn’t participated or had exited the marketplace last year are returning, Pollitz says, adding more competition to the market.
Subsidies are increasing. Subsidies still help millions afford their coverage. In all states, the upper limit for subsidy eligibility is 400 percent of the federal poverty level. According to Healthinsurance.org, the upper income cap in 2019 will be $48,560 for a single person and $100,400 for a family of four. Subsides can bring the cost down, in some cases, to less than $100 a month per person, and eHealth reports that, as the price of health insurance rises, so do federal subsidies, keeping premiums affordable this year for those who qualify.
Without subsidies, expect high premiums. Those who don’t qualify for subsidies to help lower the cost of premiums may still face daunting premiums. An eHealth analysis found that, in 2018, the average monthly premium for people not receiving government subsidies was $440 per month, while the average monthly premium for a family was $1,168 per month.
Short-term plans are now available — but buyer beware. In 2019, the federal government is allowing states to sell short-term health insurance policies with coverage terms of up to one year. According to eHealth, short-term health insurance is approximately 80 percent cheaper on average than an ACA plan purchased with no subsidies. But there is a significant catch: With lower costs come fewer benefits. Short-term policies do not need to include such benefits as maternity, mental health, prescription drugs and preventive services, which are mandated as essential health services by the ACA. Also, short-term insurers can deny coverage based on pre-existing medical conditions, which ACA plans cannot do. “If you are healthy enough to qualify, the premium may be cheaper, but if you get sick, you run the risk of paying a lot out of pocket,” Pollitz says. “If you buy one and something happens, you might be caught without coverage or it won’t stay affordable the rest of year, and losing coverage with a short-term policy does not give you the right to enroll in a full policy later in the year. These are risky, so be careful.”
It’s harder to find help. The Trump administration substantially cut funding for navigators to help shoppers find health insurance. “In some places — Iowa, Texas, Ohio, New Jersey — there are whole areas that are bare,” Pollitz says. “If there is a navigator, there may be a long queue. All the more reason not to wait until the last minute.” Other options for help include sister programs run by community health centers, hospitals and other nonprofit organizations, she says. You can find these programs by going to Healthcare.gov and clicking on the Find Local Help button.