Under the Affordable Care Act, a.k.a. Obamacare, you can sign up for health insurance on your state’s health insurance exchange or individual marketplace only during an annual open enrollment period, unless you have a qualifying life event. If you’re buying health insurance on your own (not through your workplace), you can buy from your state’s health insurance marketplace (check Healthcare.gov to find yours), directly from a health insurance company or agent, or online. If you’re buying on your own:
- Open enrollment runs from Nov. 1 – Dec. 15 for coverage starting January 1.
For 2018, the federal government cut the open enrollment period from the usual 90 days to a mere 45 days. (Some states, but not Delaware, are extending the time that people have to buy health insurance.) People who qualify for Medicaid can enroll at any time of the year.
CMS unveiled two new policies recently. First, the budget to announce the sign-up period is being cut from $100 million to $10 million. The ad campaign will include no television or radio, just digital media, email and text messages. This means signing up may not be top of mind, so mark your calendar!
Second, organizations with federal contracts to help consumers shop for coverage, known as “navigators”, will have their budgets cut from $62.5 million to just $36.8 million this year, a 39 percent cut.
- You must sign up if you don’t have health insurance from another source. That could be through your employer or your spouse’s employer or through the government (veterans, Medicare and Medicaid).
- During open enrollment you can renew your current individual/family health insurance plan or choose a new health insurance plan through the marketplace in your state or through private insurance.
If you are currently enrolled in a marketplace health insurance plan, it will automatically renew. However, the plan may make changes to its provider network, copays, co-insurance and drug coverage. Your plan must send you a notice of any changes it will make for 2018.
Take time to read the notice to see what it means for you. Make certain your doctors and preferred hospital are still in your network. Be aware: you may be able to use out-of-network doctors and hospitals if you’re willing to pay more, but in some cases, you might not be covered at all if you go out of network.
Your prescription drug coverage also could change. The plan may no longer cover the drugs you take to manage your chronic conditions, or the tier into which they fall may change. It’s important that you check your plan’s drug benefits for 2018 before you allow it to renew. Health plans must provide an online link to the list of drugs they will cover (formularies). You may need to find a different plan for your needs.
- If you miss open enrollment, you may have to wait for a year to sign up for coverage unless you qualify for a special enrollment period. Qualifying events include divorce, marriage, birth or adoption of a child, death of a spouse or partner that leaves you without health insurance, your spouse or partner who has you covered loses his/her job and health insurance, you lose your job and with it your health insurance, your hours are cut making you ineligible for your employer’s health insurance plan, or you are in an HMO and move outside its coverage area.
- Under Obamacare, those without health insurance must pay a penalty at tax time. In 2017 the penalty is 2.5 percent of your income or $695 per adult (whichever is more) and up to $347.50 for each child, with a maximum penalty of $2,085. For 2018 and beyond, the penalty will remain at 2.5 percent, but the flat and maximum amounts will adjust for inflation. f you owe a penalty, it will be taken from your tax refund.
- The marketplace gives you a choice of four levels of individual/family health insurance plans, depending on how much cost-sharing they require, and all health plans must cover 10 essential benefits.
- You may qualify for a premium tax credit based on income and family size. To qualify, your family income must fall between 100 and 400 percent of the federal poverty level (FPL).
- If you suffered a hardship, you may not be required to buy health insurance. You may qualify for a hardship exemption if you were the victim of domestic violence or suffered from a natural or human-caused disaster such as a fire or flood that damaged your property substantially; if a close family member recently died or you had unexpected expenses related to caring for an elderly, ill or disabled family member; if you have been evicted from your home or suffered bankruptcy; if you found you are ineligible for Medicaid because your state did not expand eligibility under Obamacare, and more.