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Your guide to buying individual health insurance

The current open enrollment period will be half as long as last year's. Other than that, health insurance shopping will be largely unchanged.

2018 Obamacare open enrollment is underway

The Affordable Care Act’s open enrollment period is currently underway – and it’s going to be much shorter than it was in prior years. But although the Trump Administration’s efforts to dismantle the ACA have been in the news constantly this year, the logistics of enrolling and the financial assistance available will be the same as they were in prior years.

If you buy your health insurance in the individual market, it’s essential to understand that in terms of the big picture, little has changed. Despite the seemingly unending ACA repeal battle and constantly evolving predictions about the ACA’s future, the law remains fully intact.

The individual health insurance market is functioning the same way it has since 2014 – albeit with some new regulations. The start and end dates for open enrollment have changed several times since the first open enrollment in 2013, and they’ve changed again for the current open enrollment period, as noted above. (Note that open enrollment will follow different schedules in some of the state-run exchanges).

Enrollment options haven’t changed

But the infrastructure and enrollment process remain unchanged. In a nutshell:

  • You’re still required by law to have ACA-compliant health coverage. If you don’t, you could face the individual mandate penalty. Calculate your penalty.
  • There is still open enrollment, and it’s still your only opportunity to buy ACA-compliant coverage without a qualifying event.
  • Coverage is still guaranteed-issue, regardless of pre-existing conditions.
  • With the exception of later enrollments in the state-run exchanges that have opted to extend open enrollment, all plans purchased during open enrollment will take effect January 1, 2018. (A waiting period that Senate Republicans were considering for people who had a gap in coverage was not implemented.)
  • 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 (details below).

Read our updated Insider’s Guide to Obamacare’s Open Enrollment.

Premium tax credits survive repeal battle

There are still premium tax credits (aka, premium subsidies) 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 are receiving premium subsidies that cover an average of two-thirds of the total premiums.

The Trump Administration cannot eliminate the premium tax credits. They could be changed by legislation, but GOP efforts to do so stalled in Congress in late July and again in September (Republican lawmakers have vowed to revisit the issue next year). The only thing that will change about premium subsidies for 2018 is that they’ll be larger than they were in 2017, since average premiums are increasing and the subsidies grow to keep up with premiums.

Cost-sharing subsidies remain in place

Cost-sharing reductions (CSR, aka, cost-sharing subsidies) will continue to be available in 2018, despite the fact that the Trump Administration announced in October that funding for CSR would end. This is essential to understand, as cost-sharing reductions have been the subject of a lot of the headlines over the last few months.

It’s true that President Trump has threatened throughout the year to cut off funding for cost-sharing reductions, and eventually did so, less than three weeks before the start of open enrollment. But the coverage provided by the cost-sharing reductions will continue to be available in 2018, as it would take legislative action to end it.

So even though the Trump Administration has eliminated funding for cost-sharing reductions, people with income up to 250 percent of the poverty level will still have access to Silver plans with reduced out-of-pocket costs, as long as there are insurers participating in the exchange in all areas of the country.

In anticipation of a funding cut from the Trump Administration, well over half of the states directed insurers to add the cost of CSR into premiums for 2018. This protects the markets in those states (and most consumers, since premium subsidies will cover the additional cost for most enrollees).

In other states, some insurers might opt to leave the marketplace, so there’s still some uncertainty as we head towards open enrollment. But the takeaway point is that as long as there are exchange plans available in your area, Silver plans with built-in CSR will continue to be available to eligible enrollees.

Affordable premiums still in reach for millions

Given the premium volatility that we’re facing for 2018, it’s essential for anyone who is eligible for premium tax credits – or who might be eligible with an income fluctuation during the coming year – to enroll through the exchange. 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 coming year – keeping in mind that the premium tax credits are available well into the middle class (a family of four earning $98,400 is eligible for premium subsidies in 2018), and will be larger in 2018 than they were in 2017 in order to offset the higher premiums.

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.

Exchange plans available in all U.S. counties

As of early October, insurers were slated to offer coverage in the exchange in every county in the United States. Both sides of the political aisle have been addressing this issue all year.

While previously bare counties are currently filled, it’s also possible that more insurers could back out of the exchanges in response to the Trump Administration’s decision to eliminate funding for cost-sharing reductions. We’ll continue to monitor this and update our pages about the exchanges.

But for the time being, for the most part, nothing has changed. Most of the healthcare reform headlines from 2017 never came to pass. And although it will once again be necessary to compare plans in the exchange during open enrollment and potentially be willing to switch to a different plan in order to get the best value, premium subsidies will shield most exchange enrollees from the 2018 premium increases.

Obamacare alternatives

We’re big fans of the Affordable Care Act and what it’s done to improve access to affordable coverage. We know that the law has delivered health insurance for millions who were unable to find affordable coverage on the individual market in the past. And – if at all possible – we strongly encourage our readers to take advantage of the comprehensive ACA-compliant coverage the law has provided.

At the same time, 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 – at least for 2018 coverage.

To those consumers facing high premiums – perhaps because they’re in the coverage gap or their incomes make them ineligible for subsidies – we still would emphasize that some health coverage is always better than no coverage. The good news: 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.

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:

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. 

healthinsurance.org, your trusted guide for 23 years

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