Your guide to buying individual health insurance

Obamacare open enrollment for 2019 coverage

• Open enrollment for 2019 coverage is from November 1 through December 15 (this Saturday) in most states. (See the exceptions.)
• Premium increases are lower in many cases and more carriers have returned to the exchanges.
• Our updated guide is loaded with resources to help you buy the right coverage.
• Consumers are still required to have ACA-compliant coverage.
• Premium and cost-sharing subsidies are still available – and key to affordability.
• For millions who can’t afford ACA-compliant coverage, short-term coverage that could provide a temporary safety net.
• People buying ACA-compliant coverage during OEP may need a short-term plan to bridge the gap until their coverage takes effect in 2019.
• New federal short-term health insurance rules have expanded consumers’ access to the plans.

The Affordable Care Act’s annual open enrollment period for 2019 coverage is about to end in most states. (Open enrollment for ACA-compliant 2019 coverage will end this Saturday, December 15, 2018 in all states that use HealthCare.gov, and in five of the states that run their own exchanges. This enrollment schedule applies both on and off-exchange.)

This year’s enrollment period offers good news to many Americans. After two years of carriers leaving markets and steep rate increases, states are seeing carriers re-enter exchanges for 2019 – and average rate increases are smaller than they were in 2017 and 2018.  And, although premium subsidies will be slightly decreased in 2019 (though not in all states), those eligible for cost-sharing reductions will continue to receive them.

If you need a refresher on what changes to your coverage you make during open enrollment, we’ve updated our annual guide to Obamacare’s open enrollment. It’s loaded with the information that will help you make the best possible decision about a health plan.

Need more enrollment information? We’ve got dozens of enrollment FAQs with answers to your health coverage questions.

You can also use our popular premium subsidy calculator tool to determine the size of your subsidy when you enroll through an exchange.

Your reasons to enroll haven’t changed

If you’re wondering whether it still makes sense to enroll, consider this:

• Coverage is still guaranteed-issue, regardless of pre-existing conditions.
• Premiums for older enrollees are still capped at no more than three times the premiums for younger enrollees.
• All new major medical plans are still required to cover essential health benefits.
• And the financial assistance provided by the ACA is still available, with premium subsidies that are larger than ever in most areas of the country.

Four Americans who are still enrolling – like their live depend on it

Subsidies can still greatly reduce your plan costs

Depending on your household income, you may still be eligible for premium tax credits (aka, premium subsidies) and possibly cost-sharing reductions (CSR, aka, cost-sharing subsidies).

• Premiums subsidies are still available in the exchange for people with income up to 400 percent of the poverty level. (For 2018 coverage, a single person can earn up to $48,240 and be eligible for the premium tax credit, and a family of four can earn up to $98,400). Calculate your subsidy. In 2017, 84 percent of exchange enrollees received premium subsidies that covered an average of two-thirds of the total premiums.
• The only thing that has changed about premium subsidies for 2018 is that they’re larger than they were in 2017 in most areas, since average premiums increased and the subsidies grow to keep up with premiums.
• Cost-sharing subsidies are also still available in 2018, even though the Trump Administration has eliminated funding for cost-sharing reductions. People with income up to 250 percent of the federal poverty level still have access to Silver plans with reduced out-of-pocket costs.

A few reminders about affordable coverage

Given the premium increases  ahead for 2019, it’s essential for anyone who is eligible for premium tax credits – or who might be eligible with an income fluctuation later in the year – to enroll through the exchange if and when they have a special enrollment period. Don’t sign up for an off-exchange plan and miss out on the possibility of much more affordable premiums via a tax credit.

In general, the only people who should be enrolling off-exchange are those who are 100 percent certain that there is no way they will qualify for a premium tax credit during the year. Remember that you have an option to either have the premium tax credit paid directly to your insurer each month to offset the amount you have to pay in premiums, or you can pay full price for your coverage each month and claim the full premium tax credit when you file your tax return.

But either way, it’s only available if you enroll in a plan through the exchange. If you buy your plan off-exchange, there’s no way to claim the tax credit at the end of the year, even if your income ultimately ends up at a level that would have been subsidy-eligible.

Short-term health insurance as a temporary safety net

The Affordable Care Act has delivered health insurance for millions who were unable to find affordable coverage on the individual market in the past. And, while we strongly encourage our readers to take advantage of the comprehensive ACA-compliant coverage, we do recognize that there is a segment of the individual market population that is facing daunting rate increases. We realize that their coverage options may be limited.

Many consumers face unaffordable premiums – perhaps because they’re in the coverage gap or because their incomes make them ineligible for subsidies. Even consumers planning to buy an ACA-compliant plan during open enrollment may have to wait up to two months for the new plan to take effect. If they’re currently uninsured, a short-term plan can bridge that gap.

The good news is that there’s a wide range of short-term health coverage available that could provide a temporary safety net until you can find less expensive comprehensive coverage.

New rule will make longer short-term coverage easier to buy

Consumers who are unable to afford ACA-compliant coverage can now purchase short-term coverage with a much longer duration. Federal regulation changes finalized this summer and announced this month will make it possible for many buyers to purchase a short-term plan with an initial duration of nearly a year – with renewal options that allow the plan to remain in force for three years.

Availability of those plans will varies from state to state. Check short-term coverage options in your state.

A guide to individual and family health insurance

As much as we love the Affordable Care Act, we know as well as anyone that the individual health insurance market continues to be a source of confusion for many consumers.

Since 1994, this web site has been a guide for consumers seeking straightforward explanations about the workings of individual health insurance – also known as medical insurance. Within this site, you’ll find hundreds of articles loaded with straightforward explanations about health insurance – and the health law – all written by a team of respected health insurance experts.

Our most popular resources include:

• a guide to Obamacare’s open enrollment
• a guide to ACA’s special enrollment periods
• (and a guide to the qualifying events that trigger SEPs)
• our Obamacare premium subsidy calculator
• our Obamacare penalty calculator
• frequently asked questions about insurance
• a health insurance glossary
• state-by-guides to the health insurance marketplaces
• an explanation of short-term health coverage options

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Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.