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The Affordable Care Act, also known as Obamacare, it is still in full effect this year. Open enrollment, which started on Nov. 1, will continue in most states to Dec. 15. After that, consumers will have to wait until next year’s enrollment period to obtain coverage, unless they meet special requirements.
However, there are a few changes to the enrollment process that consumers should be aware of, including changing premiums, lower subsidies and more options to choose from.
For example, a consumer who chooses to forgo enrolling in a plan won’t face a penalty when it’s time to pay 2019 taxes. Additionally, some consumers may see lower premiums but rate changes will vary by state, some increasing a lot and some going down a little.
States, including California, Colorado, Massachusetts, Minnesota, Rhode Island and Washington, D.C., have extended their enrollment periods, so be sure to check individual deadlines.
For everyone else, time is running out. If you have yet to select a plan, here’s what you need to know while navigating the marketplace.
Get a handle on your income
Estimating your 2019 income during enrollment can be tricky, but it’s one of the most important parts of the process.
Some insurance plans come with tax credits for people with incomes between 100 and 400 percent of the federal poverty level, which is $12,140 to $48,560 for one person or $25,100 to $100,400 for a family of four. About 80 percent of people who enroll in the marketplace qualify for premium tax credits, reports Kaiser Health News.
To prevent granting credits to ineligible consumers, you will be asked to provide additional information to verify your income. This could be in the form of pay stubs, tax returns and more. Healthcare.gov provides a full list of acceptable income verification documentation.
Review current coverage and alternatives
If you’re hoping to keep your current plan, make sure to review the new coverage it provides in 2019; not all plans will remain the same.
Pay attention to coverage details such as in-network providers. Consumers who get routine medical care from specialized doctors should make sure those doctors are still covered under their new plan, or existing plan if there are any changes.
Rick Notter, director of individual business at Blue Cross Blue Shield of Michigan, says thorough research should be done before deciding on a plan. Notter recommends consumers take a close look at the following points:
- Associated costs: Note the cost of copayments and deductibles. Be sure to select a plan that’s in your budget, taking into account worst-case scenarios for out-of-pocket costs. Review the costs associated with each option and the level of care required.
- Quality ratings: During the 2019 open enrollment period, quality rating scores will be displayed using a 5-star scale. The scores assigned to each plan are based on third-party data and enrollee survey responses gathered by the Centers for Medicare and Medicaid Services.
- Access to tools: While technology is common in insurances, not all providers offer telemedicine or digital tools. Consider your needs for such services before choosing a plan.
What about those cheaper, short-term policies?
In August, the Trump administration made short-term policies more readily available. These plans, which are generally cheaper and less comprehensive than long-term plans in the market place, usually don’t cover preexisting conditions. These plans are best suited for consumers who are unemployed or have a coverage gap for other reasons.
These plans are cheaper, which is a major consideration. But choosing such a plan could put you at risk.
“Because coverage and benefits are limited, relying on this type of plan for long-term coverage is not recommended,” Notter says. “In doing this, the patient risks not having continuation of coverage for emergencies or other unexpected health care costs.”
Where to find help
Obamacare’s navigator program was designed to help consumers select a plan. However, the program has seen another funding cut for the 2019 enrollment period. This year, the program awarded $10 million to 39 organizations, down from $37 million to 90 groups last year. Some states, including Iowa and Montana, will not have navigators.
Since assistance will be scarcer, consider getting started with the enrollment process as soon as possible. That way, you won’t be scrambling at the end to make an uneducated selection.
Those who live in a state without navigators can access Healthcare.gov’s FAQ page. Further assistance can be obtained through contacting the website’s customer service number.
What to do if you miss out on enrollment
Should you miss the Dec. 15 deadline of enrollment, you might not have to wait until the next open enrollment period. Special enrollment periods are granted to individuals who have lost a job, had a child, lost coverage through a family member, moved, had a change in eligibility or the loss of a plan member.