With healthcare being a hot topic of political discussion in 2017, it’s understandable that many people are confused about getting covered for 2018. But for all the attempts by lawmakers to modify the current system, the existing process for individuals to purchase insurance remains intact.
In fact, the yearly period when you can enroll in a private, individual health insurance plan for 2018, the Open Enrollment Period, is quickly approaching, running from November 1, 2017, to December 15, 2017. To make sure you’re ready, here’s everything you need to know about Open Enrollment and getting coverage for next year.
Do I need health insurance?
Yes, you need health insurance. It covers care for treating illness and accidents, protecting you from unexpected, high medical costs. It also covers preventive care such as check-ups, vaccines, and screenings.
If you don’t have health insurance, you will pay all your medical bills out of pocket—and you may also have to pay a fine. The Individual Mandate Penalty is a federal fine assessed with your tax returns. In 2017, the penalty was 2.5% of your total household adjusted income or $695 per adult (whichever was greater) and $347.50 per child, up to a maximum of $2085. The 2018 penalty amounts have not been announced, but are expected to increase.
How do I get health insurance?
If you don’t have already health insurance through a job, your spouse, a parent, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source that provides qualifying health coverage (i.e., minimum essential coverage), and you are a US citizen or national living in the US, you are eligible to enroll in health coverage through the Health Insurance Marketplace, AKA the health insurance exchange.
You can apply for coverage through the Marketplace on HealthCare.gov or on your state’s own online marketplace, by phone (1-800-318-2596), with in-person help from a community assister with Marketplace training, through an agent or broker, or via mail with a paper application.
How do I choose a health insurance plan?
To choose the best health insurance plan for you and your family, you need to compare plans’ benefits and provider networks. You can preview 2017 health insurance plans and price estimates on HealthCare.gov, though 2018 information is not yet available.
Note: If you are currently enrolled in an ACA-participating individual health insurance plan and allow yourself to be automatically re-enrolled for 2018, be aware that your premiums and other out-of-pocket charges are likely increasing—especially if you are enrolled in a “silver”-tier plan. Your insurance provider should have mailed you information regarding pricing changes. Be sure to shop around to ensure that your current plan is still the best one for you.
1. Decide which type of plan is best for you
The most common health insurance types are health maintenance organization (HMO), preferred provider organization (PPO), and point of service (POS).
HMO plans require you to see in-network providers except in case of emergencies. HMO is best if you want lower out-of-pocket costs and a primary doctor that coordinates and authorizes your care for you.
PPO plans do not require you to see in-network providers, but in-network care is less expensive.
POS plans do not require you to see in-network providers, but in-network care is less expensive and you will need a referral for out-of-network care.
Generally, a HMO or POS plan is best if you are OK with your primary doctor choosing your specialists for you. If you’d rather choose your doctors, a PPO plan is the better option.
2. Compare plan provider networks
If you have a preferred care provider and wish to continue seeing them, make sure that they’re in the provider network for the plan(s) you’re considering. If you don’t have a preferred care provider, exclude from consideration any plans without a large network of local practitioners.
3. Determine whether you need more coverage or prefer lower premiums
Compare the plans’ benefits summaries to determine how much you’ll pay out of pocket for services. In general, the lower your monthly premium, the higher your out-of-pocket costs; the higher the monthly premium, the greater the portion of your medical costs are paid.
If you are in good health and rarely visit a doctor, a plan with lower monthly premiums is likely the most cost-effective choice. Alternatively, a plan with higher monthly premiums may ultimately save you money if you visit care providers frequently.
4. Check how the services you’ll need are covered
If you see a mental health care provider, receive physical therapy, have a medication prescription for a chronic condition, are pregnant or are planning to get pregnant, or have any other health situations that require care, confirm that the plan you’re considering covers it. Some plans have better coverage for some items than other plans, and some plans have expansive coverage for some items but less for other items.
Once you’ve decided on the best plan for yourself, enroll by paying your first month’s premium. Your coverage will begin January 1, 2018.
Why don’t doctors accept all insurance plans?
“The physician decides whether they wish to participate in a particular plan,” says Nick Schilligo, Vice President of Public Policy with the American Osteopathic Association. “The reasons vary. It could be the reimbursement rate, the payment rate for services that they contract with the plan for. Or it could be that the doctor already has an adequate patient population so they don’t need to sign up to get new patients in the door. A new physician opening a practice might accept a variety of contracts and payers to make sure they have enough patients to keep the practice going. But after they have maxed out their patient load, they may be unwilling to take on additional plans and admin.”
How will President Trump’s actions on ACA affect my healthcare coverage?
On October 12, 2017, the president signed an executive order to weaken the ACA by allowing for more insurance companies to offer cheaper plans that aren’t subject to ACA regulations, including coverage for essential health benefits such as maternity and newborn care. Insurance plans with more comprehensive coverage would become more expensive as a result, making them unaffordable for the people who need them most.
These changes won’t take place immediately as federal agencies must figure out how to implement them. The order will probably lead to major changes for 2019, however.
Unfortunately, Trump did create additional uncertainty that same day for 2018 enrollments by immediately cutting off federal subsidy payments to insurers, subsidies which help reduce costs for low-income consumers. As a result, many insurance providers have increased the amount they have raised their prices by—from less than 10 percent on average, to more than 40 percent.
How will a repeal or replacement of ACA affect my 2018 enrollment?
Any healthcare laws passed in 2018 will require months of planning and action to implement. It is highly unlikely ACA will be dismantled without an alternative in place, and even less likely that 2018 ACA enrollments would be affected.
What if I miss the Open Enrollment Period?
After December 15, 2017, you can enroll in 2018 health insurance coverage only if you qualify for a Special Enrollment Period due to a special life event such as a loss of a job, getting married, having a baby, or adopting a child.
Note: The Open Enrollment Period for the 2018 plan year begins November 1, 2017, and runs for 45 days, ending December 15, 2017. That’s a change from last year, when Open Enrollment ran through January 31, 2017.