If you need to buy a health insurance plan through the Affordable Care Act (also commonly referred to as the exchange, the ACA, or Obamacare), there are a number of important facts that you must know for 2018 open enrollment. As someone who has purchased health insurance through the ACA several times, I know how important it is to have this information. Here are the details you need for open enrollment this year. (See also: The One Question You Need to Answer to Choose the Best Health Care Plan)
What is open enrollment?
Open enrollment is a time period at the end of the year when anyone can buy a new health insurance policy for the following year if they don’t have health insurance through another source (such as an employer).
Is open enrollment the only time to get health insurance through the ACA?
To be eligible to enroll in a health insurance plan through the ACA outside of the open enrollment period, you must have what’s known as a qualifying life event. Healthcare.gov’s screener tool provides a questionnaire that tells you whether or not your life event qualifies you for a special enrollment. If it does, you will be directed to the appropriate website where you can purchase a new health insurance policy.
How do I get started in open enrollment?
Depending upon the state in which you claim your residency, you will either have a state-specific exchange or you will be a part of the federal exchange program. Healthcare.gov directs you to the appropriate Marketplace for you when you enter your ZIP code at the start of the process.
When is open enrollment this year?
Open enrollment begins on November 1 and ends on December 15. It’s important to note that open enrollment is a full six weeks shorter than it has been in years past, so you have much less time to enroll than you would have had in previous years. Some states that run their own state exchanges have extended their open enrollment period beyond the federally set end date of December 15. For example, my home state of New York has decided to make January 31 the end date for its open enrollment.
How does open enrollemt benefit consumers?
It may seem trivial, but open enrollment does offer people several benefits.
Locks in rates and benefits
Having an open enrollment period locks in the monthly cost (premium) that you pay to have health insurance for an entire year. Locking in your premium means that insurance companies cannot change it during that year. Because the benefits of your plan are also locked in for the year, insurance companies can’t deny you any of the coverage you purchased during open enrollment.
Covers pre-existing conditions
Thanks to the ACA, you cannot be denied health insurance because of a pre-existing health condition. Before the ACA, it was legal for a health insurance company to deny coverage based on pre-existing conditions.
Provides minimum essential coverage
All plans available through the ACA must provide what’s known as minimum essential coverage. This includes:
Ambulatory patient services. This is any service that takes place outside of a hospital and includes visits to a doctor’s office, health clinic, or urgent care center.
Chronic condition treatment. Chronic conditions are illnesses that must be consistently treated to prevent or slow their progression. They may or may not ever be fully cured. These include asthma, high blood pressure, high cholesterol, and diabetes.
Emergency room services.
Laboratory services. These services include tests that help doctors diagnose your illness or condition. Blood work and screenings are examples of lab services.
Maternity and newborn care.
Mental health services and addiction treatment. This includes both inpatient and outpatient services. Inpatient services are those that require you to check in to a facility for multiple days of treatment. Outpatient services are those that occur in an office visit to a therapist.
Pediatric services. This includes checkups, vaccinations, and immunizations, as well as dental and vision care.
Preventive and wellness services. This includes physicals, immunizations, and screenings. For women, this also includes well visits to a gynecologist. Many times, these services are included in the insurance plan with no extra fee other than a copay if you go to a service provider who is in-network. In-network means that a service provider is preapproved by the insurance company. These in-network lists are available to you directly from the insurance company.
Rehabilitative services and devices. This includes inpatient and outpatient services that help you to recover from an illness or injury.
What if I can’t afford the monthly premium for a plan on the ACA?
As of right now, the ACA offers subsidies to people who have incomes that are below certain thresholds. These subsidies are directly applied to your premium so your monthly bill is less than it would be without the subsidy. When you are on the ACA website, it will ask you if you’d like to see if you qualify for a subsidy. If you select yes, it will walk you through a short series of questions about your income to see if you qualify. If you do qualify, it will tell you how much of a subsidy you can receive, and you will be able to apply for it directly on the site. The subsidy will then be reflected on each of your monthly premium bills.
How can I find out if I qualify for Medicaid?
Some states have chosen to expand their Medicaid programs to cover more of their residents. To find out if you qualify for Medicaid, choose your state and household size on Healthare.gov and the site will tell you if you qualify.
I’m still confused about what I need to do to get health insurance through the ACA. What should I do?
Healthcare.gov has worked hard to train its customer service agents to provide phone support for people who need additional help. A page on their website details what you should know before you call as well as the contact numbers for you to use. I have personally used New York’s customer service line, and I received helpful, timely, and excellent service.
If you need to buy insurance through the ACA, I highly recommend selecting your plan as early as possible in the open enrollment period. Having health insurance is one of the most responsible personal finance actions you can take to care for yourself and your family. If you need or want to purchase your own health insurance for 2018, please make sure to go to Healthcare.gov between November 1 and December 15.