Most Americans get health insurance through their employer or a family member's workplace. However, 20 million people are now buying health coverage through an insurance marketplace. If you bought insurance through the exchange last year, or are considering buying from the exchange this year, the National Association of Insurance Commissioners (NAIC) has some information to make the process a little easier.
Health insurance marketplaces, or exchanges, operate in every state. These online portals ask a series of questions to determine which plans meet your needs. They also determine if you are eligible for any subsidies or alternative coverage through Medicaid or the Children's Health Insurance Program (CHIP).
You can apply online, by mail or in person. If you get coverage through Medicare or an employer, you don't need to apply for coverage through the exchange. Open Enrollment is the period in which you can shop and sign up for insurance coverage in the exchange. Open enrollment starts Nov. 1, 2017 and ends Dec. 15, 2017. If you don't enroll in a health insurance plan by Dec. 15, 2017, you can't enroll in a health insurance plan for 2018 unless you qualify for a Special Enrollment Period. Plans sold in the individual market (off the exchange) also follow these dates.
Key Dates for Open Enrollment
Nov. 1, 2017: Start of Open Enrollment – first day you can enroll in a 2018 insurance plan through an exchange.
Dec. 15, 2017: Last day to enroll (or change plans) for coverage starting Jan. 1, 2018.
If You Enrolled Last Year
If you purchased health insurance through the marketplace last year, you will be auto-enrolled in the same or similar plan unless you select a different plan by Dec. 15. If your health insurer for 2017 is no longer offering coverage through the ACA marketplace, the government will select a health plan for you unless you opt out of the exchange or select a plan on your own.
Take time to verify your information and look at the available policies. There may be a new option that is less expensive or better suits your needs. Even if you are auto-enrolled in a plan, you are able to choose a different plan at any time during the open enrollment period.
In addition, your eligibility for subsidies depends on your income and available policies in your area. Either of these may have changed from last year. Even if your income and chosen plan have not changed, if there is a less expensive option it could affect the amount of a subsidy. If you do not complete a new eligibility determination, you may be responsible for repaying the difference between what you are currently receiving and what you should receive when you file your 2017 taxes.
New to the Exchange?
If you had a plan that is no longer offered, you may have already received a cancellation notice. That means the insurance company is unable to or has chosen not to renew that policy. Some plans were extended for one year and are no longer available. You should review all of your insurance options, including purchasing on the exchange. You can still purchase insurance "off" the exchange in the individual market, but you will not be eligible for subsidies.
Plans sold on the marketplace fall into one of four categories: bronze, silver, gold or platinum. The different categories represent what an average enrollee would pay out-of-pocket. All plans must cover 10 essential health benefits (EHBs).
If you purchase a bronze plan, you would pay a higher portion of the total cost of the care you receive than you would if you had a gold plan. While bronze plans have lower premiums, they also have higher deductibles, co-pays and coinsurance levels. These all increase your costs if you need medical care.
Rates on the Exchange
Exact rates may depend on age, family size, geographic location and tobacco use. In addition, some people may qualify for subsidies based on their income. These subsidies come in the form of a tax credit, applied to your monthly premiums, and cost-sharing reductions, which increase the value of silver plans for those who qualify.
Each state has a program to assist consumers with understanding their options. While the actual names may vary by state, each state has some form of assistance available. It may be an individual or an organization, but trained navigators, application counselors and in-person assisters are able to help you learn about the available choices and guide you through the application process. These assisters may not be licensed insurance agents and if not, they cannot recommend a specific insurance plan or sell you insurance. A trained and licensed insurance agent or broker can help you find the right policy. They can recommend a specific plan, but they may be limited to selling for a particular company.
If you have questions about the health insurance marketplace in your state, contact your state insurance department. For more information on NAIC activity on health care reform, visit the Health Care Reform Special Section. You can find more information on the ACA on the Health and Human Services website.