Throughout the past six months, political upheaval over healthcare reform caused many Americans to worry about the future of their coverage through the Affordable Care Act. Now that Congressional leaders have made healthcare reform a lower priority, those seeking health insurance plans through HealthCare.gov can focus on the upcoming enrollment season. The current administration proposed that the 2018 enrollment season will begin on Nov. 1 and last for 45 days. This means that the enrollment period will end on Dec. 15, giving Americans a short window of time to choose their plan. In addition to a shorter enrollment period, there are six changes that you should know about.
#1. Streamlined Enrollment
Last year, thousands of consumers faced technical difficulties when enrolling via health insurance broker websites. A “double redirect” would move customers from an online broker’s enrollment page back to the HealthCare.gov site and back again to verify income for subsidies, creating a frustrating and sometimes confusing experience. In fact, many customers chose not to enroll after dealing with the hassle.
The double redirect has been eliminated for 2018, allowing consumers to visit a broker’s site and apply for a plan without leaving the site at all. This is expected to create a seamless, more organized enrollment process. Since consumers will only have 45 days to make their insurance selections, a more streamlined process will be beneficial.
It’s important to note that those who require additional paperwork or supporting documents may be affected by a double redirect. Plus, those who apply outside of open enrollment will also experience the double redirect when visiting a broker’s website. The new enrollment process will only be available from Nov. 1 to Dec. 15.
#2. Higher Premiums and Penalties for Some
Lack of participation among young and healthy consumers coupled with healthcare reform uncertainty led to higher premiums in 2017. Many insurers withdrew their plans from the marketplace, giving consumers fewer options and overwhelming the remaining carriers. Rates will rise in most places because the insurance companies cannot rely on cost-sharing reduction payments. Insurance carriers also can’t rely on the Trump administration, which has been staunchly against the Affordable Care Act, to enforce the individual mandate. While these higher premiums won’t affect consumers who receive subsidies from the marketplace, some customers will see substantial cost differences.
Penalty charges might also affect you this year. If you didn’t pay your monthly premiums and dropped your coverage in 2017, you will likely be required to pay any unpaid premium charges before enrolling in a new plan with the same insurer. A new rule issued by the CMS allows insurance carriers to require enrollees to settle past debts before receiving new coverage. Insurance carriers must follow state laws when collecting past debts, and penalties only apply if the customer is trying to re-enroll with the same carrier. These penalties were designed to encourage consumers to keep their health plans for the year.
#3. Updated Special Enrollment Rules
Over the past few years, it has been relatively simple to apply for a special enrollment period, which can give you more time to complete the sign-up process. The government was relaxed when it came to collecting supporting documentation, leading many people to take advantage. This year, the government is cracking down on fraudulent use of the special enrollment period. Consumers wishing to use the additional time will have to jump through more hoops when signing up.
For example, those who lost their health insurance due to nonpayment won’t qualify for an SEP. They’ll have to sign up during the next open enrollment period. Even if you do have a valid qualifying life event, you may still be subject to a lengthy screening and verification process. Your application will be held until HealthCare.gov receives the information it needs, and you’ll only have 30 days from your application date to gather the paperwork.
Plus, adding a dependent or spouse to your plan doesn’t allow you to pick a new plan or carrier. Instead, you will need to add the new person to your existing plan and make any additional changes during the enrollment period.
#4. Actuarial Flexibility
Insurers will have more leeway in actuarial values in 2018, making it easier for consumers to choose an affordable plan. Health plans are offered under four tiers with the ACA, each with different actuarial values that represent the average of how much the plan covers: bronze (60 percent), silver (70 percent), gold (80 percent) and platinum (90 percent). The law doesn’t offer much flexibility with these values, which keeps insurers in a fairly strict bind when setting rates and coverage limits.
A new rule for 2018 will allow silver, gold and platinum plans to have a -4/+2 variation on their actuarial values, while bronze plans can have a variation of -4/+5. This means that a silver plan could cover between 66-72 percent, with the exception of the second lowest-cost silver plan. This benchmark plan is used to determine subsidy rates for qualified customers.
Giving insurance carriers more flexibility when setting rates could be a good thing. On one hand, consumers will have more choices when choosing a plan that’s within their budget, possibly getting a better plan for slightly more money. On the other hand, expanded variance in actuarial value might make comparing plans more complicated. For example, a gold level plan with an actuarial value of 76 may seem similar to a silver plan with an actuarial value of 72. Enrollees will need to closely examine each plan’s coverage and pricing – and potential out-of-pocket costs – when signing up in 2018.
#5. Fewer Options Nationwide
When the CMS released a map in June showing plan availability by county in the U.S., it brought bad news for the 35,000 people living in 47 counties. These counties were expected to have zero choices for insurance carriers due to companies withdrawing from the marketplace. Smaller and lesser-known carriers have stepped in since then, and now those counties will have at least one option for coverage in 2018.
Unfortunately, plan options have dwindled in many parts of the country for next year. Approximately 23 percent of marketplace customers throughout the nation – 2.5 million people – will have just one carrier option on the exchange, while 26 percent will have only be able to pick from two carriers. While choices will be scarce in some areas in 2018, there is some hope. Insurance providers have until September 27 to decide whether they will participate in 2018, so there may be some last-minute additions.
#6. Uncertainty Over Penalty Enforcement
President Trump has encouraged letting the healthcare industry collapse under the weight of Obamacare’s shortcomings. The Trump administration has not pledged to continue cost-sharing reduction payments beyond this month, let alone next year, which is one reason that premiums are rising in 2018. Even more uncertain is the future of the individual mandate, which requires every American to hold health insurance or receive a penalty at tax time. There is no confirmation that the penalty will be enforced, since President Trump issued an executive order in January stating that any agency that administers the ACA can waive fiscal burdens on individuals. However, the IRS claims that it will continue to enforce the mandate despite President Trump’s position.
Even though the IRS has stated that it will enforce the penalty at tax time, many Americans don’t believe that the mandate is active – and insurance companies don’t necessarily believe it either. In fact, lack of clarity over the mandate has forced some carriers to set higher premiums to help offset financial losses caused by people not signing up for coverage. Without the mandate in place, young and healthy people – the demographic most needed to sign up – may avoid enrollment. Unsurprisingly, insurance companies are setting their pricing accordingly.
The official position of the IRS is that it will be holding Americans accountable for not choosing a healthcare plan. The penalty for not receiving coverage is the greater of a flat fee or 2.5 percent of your household’s taxable income.
While there may be other changes in 2018, these are what you need to look out for when thinking about plan options and affordability. Open enrollment for 2018 will begin on Nov. 1 and last through Dec. 15. Coverage will begin on Jan. 1.