Open enrollment for health insurance is less than two months away. And if you’re thinking of signing up for an Affordable Care Act plan, you’re probably more than a little confused and anxious.
While GOP efforts to repeal or replace the ACA failed over the summer, the Trump administration has already taken several steps that could make signing up more difficult.
For one, last week it slashed the advertising budget for open enrollment by 90 percent, from $100 million to $10 million. For another, it cut in half the grants to ACA “navigators,” experts trained in helping people sign up for coverage.
In addition, over the past six months the Trump administration and some Republicans in Congress have been raising red flags about the ability of people to find affordable insurance plans this coming fall, warning that many insurers were pulling out of markets and that premiums and deductibles would be skyrocketing.
Yet there have been recent indications that health insurance plans this coming year will be both more widespread and affordable than feared.
For example, new research shows that every county in the U.S. will now have at least one insurance company offering individual coverage, and most will have several. In addition, several insurers have recently lowered their requested increases on premiums for the plans they expect to offer in 2018.
In addition, Congress is heading back to work this week with bipartisan talk afoot about not repealing or replacing the ACA, but repairing it.
Groups of Republicans and Democrats in both the House and the Senate, along with several Democrat and Republican governors, have each come up with proposals on how to shore up the individual market.
Still, health insurance experts worry that that all the dire warnings and mixed messages have left many consumers hesitant about signing up for an ACA plan this year.
"Choosing a health care plan has always been a complex decision,” says Kev Coleman, head of research and data at HealthPocket.com, a health insurance research and comparison website. “People are hearing contradictory pieces of information from different sources. It would be impossible not to be confused this year.”
Here is the truth behind some myths about enrolling in ACA health insurance for next year.
Myth: You Will Have Few Insurers to Choose From This Year
Truth: Though a number of insurers have pulled out of ACA marketplaces because of the uncertainty about the future of the ACA, others have stepped in to fill those gaps.
As of late August, every ACA marketplace will have at least one insureroffering plans for 2018, according to the Kaiser Family Foundation. More than half of ACA markets will have two or more insurers, according to the latest data from the Centers for Medicare & Medicaid Services.
But even if you are in a market with only one insurer, you'll have still have choices, says Coleman from HealthPocket.
Under ACA law, insurers must offer at least one Silver and Gold plan and many also offer options from the two other metal tiers: Platinum, which is the highest, and Bronze, which is the lowest.
Metal categories differ, with Bronze and Silver offering lower monthly premiums than Gold and Platinum plans in exchange for higher deductibles. You should weigh those choices carefully, Coleman says.
And though the Trump administration has cut back funding for navigators, if you need help there will still be people to assist you. At HealthCare.gov, you can search by city and state or ZIP code to see a list of local organizations that can help you. And some states, such as California, have their own separately funded navigator and outreach programs.
Myth: You Won't Be Able to Afford the Premiums
Truth: To be sure, some insurers are asking regulators for double-digit rate hikes, which could slam middle-income people, who often don't qualify for financial assistance to help pay premiums.
But some 85 percent of people who buy health insurance on the ACA exchanges do get subsidies to reduce premiums. And those who choose Silver plans get additional help to cover other out-of-pocket costs, such as deductibles and co-pays for doctor visits and treatments.
Moreover, rates are not expected to rise sharply everywhere. Insurers in Indiana, Alabama, and Massachusetts, for example, are seeking only single-digit increases, according to ACASignups.net, which is tracking the rate filing data.
In some states—Oklahoma, Alaska, and Minnesota, for example—regulators are securing lower rate increases than insurers have requested.
Myth: You Won't Be Penalized If You Don't Buy Insurance
Truth: While the Trump administration initially gave mixed signals about whether it would continue enforcing the ACA's individual mandate—the requirement that everyone buy health insurance or pay a penalty—the IRSrecently sent out letters reaffirming its intentions to follow through on the mandate.
Under the ACA, people must sign up for health insurance or else pay a penalty: $695 per person or up to $2,085 for a family.
This is meant to ensure that even healthy people sign up for health insurance—something that's necessary to create a more balanced pool of people on the marketplace exchanges. If healthier people don't enroll, insurers may be left with a sicker and costlier group of people to cover, which could drive up premiums.
“It’s still the law of the land, and the IRS says it will be enforced,” says Timothy Jost, a health policy expert and emeritus professor at Washington and Lee University School of Law.
If you don’t sign up for health insurance and don't qualify for an exemption, the IRS will send you a notification letter and take the money out of future tax refunds.
Last year the IRS collected $2.8 billion in penalties, from 4 million Americans.
by Donna Rosato | Sep 5, 2017