As we draw closer to this year’s shortened health insurance marketplace open enrollment period, we want to highlight a few final details regarding metal levels, application process, subsidies, tips for those already enrolled and other things to consider.
As we have noted in previous blogs and a recent Community article, taking time now to consider your insurance needs is especially important because this year you have only 45 days to enroll in individual coverage: Nov. 1-Dec. 15. Last year, individuals had three months—Nov. 1 -Jan. 31—to review and enroll into plans.
If you need to change your existing coverage or enroll into a new plan, it is essential that you do so by the Dec. 15 deadline. If you miss the deadline, you will not be able to obtain coverage until next year’s enrollment period, unless you qualify for a special enrollment period, triggered by a qualifying life event.
And as a reminder: To avoid paying a fine at tax time, you must be enrolled into health insurance that is considered creditable coverage, meaning it is compliant with the Affordable Care Act (ACA) guidelines.
Most ACA-compliant plans are categorized by four metal levels—bronze, silver, gold and platinum—making them easy to recognize. The different metal types correspond with the level of coverage and costs of the plan.
What if I’m already enrolled?
If you are currently enrolled in a marketplace plan, you still need to take action.
For one, your plan may not be offered in 2018. Several insurance companies that offered plans in 2017 have pulled out of the marketplace for the 2018 plan year. If your plan is no longer offered, you should receive notification by mail. According to ACA law, the insurer must notify you by mail at least 90 days prior to your plan’s end date.
Additionally, new companies may have joined the 2018 marketplace, presenting new plan options to consider during open enrollment.
Finally, if your current plan is still being offered for 2018, you may keep the plan or review other available options. Whether you are new to the marketplace or re-enrolling into your current plan, you will need to complete an application with the marketplace during enrollment. (It is also important to update your application whenever applicable, such as when your income, household size or contact information changes. This will ensure the marketplace has accurate information and can make adjustments to subsidies when appropriate.)
What does the application involve?
When completing the marketplace application, you will need the following information:
- Household size (regardless of who is applying for insurance).
- Estimated household income for 2018.
- Information on how you file your taxes.
- Addresses, birth dates and Social Security or document numbers for everyone applying for coverage.
- Information about current insurance, including type, company name and policy numbers.
After completing the application, you will receive your Eligibility Determination Notice. It is important to read over this document carefully because it advises whether you are eligible to purchase a Marketplace plan, if you qualify for any subsidies and if any additional information or documentation is required along with any applicable deadlines. If you disagree with your determination, you have the option to appeal.
What are subsidies?
Based on your estimated yearly household income, you may qualify for help with plan costs. While you are not required to file taxes to qualify for enrollment, you must agree to file taxes for the plan year in order to receive the subsidies. If you do not file your taxes after utilizing the subsidies, you could owe the Federal government that money.
There are two types of subsidies:
- Advanced Premium Tax Credit: This tax credit helps lower the cost of the plan’s monthly premium. To be eligible your income must be between 100 and 400 percent of the federal poverty level. If you qualify, you can choose to use some, all or none of the credit and you can adjust the amount you use throughout the year. Keep in mind that since this is based on estimated yearly income, it is better to underestimate your income. Otherwise you risk owing money when you file taxes. This works the other way as well: If you end up having a lower income than stated on the application, you would receive the difference of the tax credit you would have qualified for in your tax refund. If you choose not to use the tax credit and later determine that you qualified, you will receive the full credit when you file your federal tax return.
- Cost Sharing Reductions: Cost-sharing reductions help reduce your share of health insurance costs, such as the deductible, copays, coinsurance and out-of-pocket maximum. To qualify for cost-sharing reductions, your income must be between 100 and 250 percent of the federal poverty level, and if you wish to utilize these benefits, you must enroll into a silver level plan.
In certain states, if the income you estimated on your application appears to be within guidelines for Medicaid, your application will be transferred to your state’s Medicaid office to determine whether you qualify for that program.
Important things to consider when reviewing plans
- Are your physicians and medical facilities in-network? You can check this by viewing the provider directory on the plan’s website or by contacting the plan directly. We highly recommend verbally confirming with the offices of your health care providers regardless, to ensure they accept any new plan you are considering or that they will remain in your plan’s network. This is also important if you are keeping your current plan to ensure there have been no changes from the prior year. (Learn more about provider networks here.)
- Are your medications covered? Each plan’s formulary will provide important information about covered medications, such as the drug tier or any restrictions on the medication (e.g. prior authorization, quantity limit or step therapy).
- Is the plan affordable? Consider the out-of-pocket costs and their affordability for your situation. These costs can include the monthly premium, deductibles, copays, coinsurance and the out-of-pocket maximum. (See CVC’s health care glossary for term definitions.)
If you live in California, Colorado, Connecticut, Washington D.C., Idaho, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont or Washington, your state operates a state-based marketplace. This means you must utilize your state’s specific marketplace website or contact number for information on available plans and enrollment. These states also have the flexibility to extend the open enrollment period deadline, providing additional time to review and enroll into plans. It is important to take note of the open enrollment period dates specific to your state. Find more info here.
The remaining 39 states operate under the federally facilitated Marketplace. If you live in one of these states, your enrollment options include:
- Online: healthcare.gov.
- By phone: call the marketplace at 800-318-2596.
- In person: search online for local assistance at localhelp.healthcare.gov.
- By mail: request a paper application
- Contact the insurance company directly to enroll. (This is different from prior years where insurance companies were required to direct you back to the marketplace to proceed with enrollment.)
If you have questions or need help reviewing plans that are available in your area for the 2018 open enrollment period, Caring Voice Coalition has a Health Insurance Counseling team that is happy to help. Please do not hesitate to contact us with any questions at 888-267-1440.
See also: Health care glossary