Health Insurance and the Holidays

Tis’ the holidays and that means two things: extra turkey and good ol’ open enrollment. This year especially can be extra tricky for those individuals and families under the 2018 Affordable Care Act (Obamacare). The questions on everyone’s minds are “What are the changes and what exactly do I need to know?”

The state of America’s healthcare system has always been up for debate and there is no questioning that there has been a tremendous amount of change this year. Some might even say we have a few “Grinches” attacking access to affordable healthcare and reproductive care. That being said, reviewing your options can be key in saving you from losing out on hundreds (or even thousands) of extra dollars over the coming year.  

Here is what you better watch out for this season:

1 | The open enrollment deadline change — it cuts your time to enroll in half!

This year you have 45 days to enroll, unlike previous years where you had three months. Open enrollment starts November 1st and continues through December 15th. But remember, your coverage doesn’t start immediately; your coverage will start when the ball drops in the new year on January 1st, 2018.

2 | Under the Affordable Care Act (ACA) you must have health insurance or the only gift you’ll get from our government is coal (aka: you’ll pay a penalty at tax time).

To get off the “naughty list,” you’ll need to sign up for health insurance during open enrollment if you:

  • Are over the age of 26 and are no longer on your parents’ healthcare plan.
  • Don’t have health insurance through an employer-sponsored plan.
  • Don’t have coverage through a government plan (such as veterans, Medicare and Medicaid).

If you miss open enrollment, you won’t be able to enroll until next year unless you qualify for the special enrollment period.

3 | You have several options for purchasing a policy:

You can purchase a policy from your state’s health insurance marketplace (on exchange) or directly from a health insurance company (off exchange).

To help further guide you and at no additional cost, the best resource with your healthcare shopping is a health insurance agent/broker. They are like the ACA’s “Elves” ready to shop out carriers, plans and networks — all while being mindful of your budget and healthcare needs.  

4 | You have a choice of four levels known as metal tiers:

Plans are divided primarily into four metal tiers:

  • Platinum — has the least out-of-pocket expenses for services (higher premiums)
  • Gold
  • Silver
  • Bronze — has higher out-of-pocket expenses for services (lower premiums)

Each metal tier has their respective cost-sharing. Typically, the higher the premium, the lower your cost-sharing.

5 | “Nightmare before Enrollment” — selecting your plan.

Selecting the right plan can get overwhelming. It all depends on how much health care you’ll need in the coming year. Do you visit the doctor frequently? If so, you’ll want a plan with lower out-of-pocket expenses for services — but say hello to that higher premium!

If you’re healthy, and your doctor’s visits are minimal, you may decide to enroll in a plan with lower premiums but higher out-of-pocket expenses for services. Selecting a low premium plan has its risks since you never know what’s going to happen. Remember, once you enroll in a plan, you can’t change it and are locked into that plan for the entire year!

This dilemma is what I like to call the “Nightmare before Enrollment.” The best place to start is by taking a look at your current plan details, reviewing the pros and cons of the plan and then using that as a baseline in selecting a new plan on the marketplace. If that doesn’t help, this is where a knowledgeable Elf/Health Insurance Broker can step in to help guide you with selecting a plan that’s right for you.

6 | Did a Grinch steal my tax credits/subsidies?

Not exactly. On Thursday, October 12th, 2017 the Trump Administration announced their plan to withhold the cost-sharing subsidies that the government currently pays insurance companies in order to reduce deductibles and co-pays for many low-income individuals. Insurance companies must continue providing these cost-sharing discounts because the subsidies are required by the ACA. Premium assistance for 2018 will be available for those who qualify.

Many insurance companies anticipated President Trump’s move to eliminate funding, and as a result premiums are being raised significantly for 2018. Those anticipated increases are reflected as a surcharge added to Silver plan premiums. This surcharge is known as the “cost-sharing reduction surcharge” and will increase the gross premium of a plan. Individuals who qualify for premium subsidies won’t be affected as much, however they may need to shop plans to keep their premiums at bay. This will mainly affect those who earn too much and exceed the income limits to receive premium subsidies. It’s now up to Congress to come up with a better resolution.

So this holiday/healthcare season, remember to shop around before you buy. Know that you are not alone and can always consult a Health Insurance Agent/Broker to help select the right plan for you. They are the season’s magical Elves who will give you the peace of mind you need so you can be free to eat all the turkey you want and enjoy the most wonderful time of the year!

Salma Zaidi is an Insurance Broker licensed in the states of California and New York. The Fullest Readers may contact her through her website or directly at salma@cagrouphealth.com.

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