Navigating Marketplace Open Enrollment

By Julie Burke, Family Health Care Outreach Specialist

​In recent months, there has been a lot of discussion about repealing and replacing the Affordable Care Act. These discussions at the national level have created some confusion with where the law currently stands. As of the end of October 2017, the most recent attempts to repeal and replace the Affordable Care Act have not been passed. What does this mean for those enrolled or who are eligible to enroll in the health insurance Marketplace?

The individual mandate that requires all citizens to have health insurance is still in effect. Those who do not have the minimum essential coverage will be fined.  The fine for 2018 is 2.5% of household income, or $695 per adult and $347.50 for each child under the age of 18.  The fines will be assessed at whichever of the two are higher, but cannot exceed $2,085. To see if you qualify for one of the exemptions available, visit www.healthcare.gov and search for “fee for not having health insurance”.

There are two subsidies available to help keep premiums and out-of-pocket costs down. The first is the Premium Tax Credit (PTC). The amount of the PTC is based on your household size and income, and can help keep the monthly premium costs affordable. PTCs can be used in any plan. The second subsidy is called Cost Share Reduction. This is also based on household size and income, and provides cost savings for out-of-pocket expenses like deductibles and can reduce the maximum out-of-pocket costs.  These savings are only available for “silver plans” offered in the Marketplace.

There are some changes to the Affordable Care Act for this year. The first is the reduction of the open enrollment period by six weeks.  You must enroll, change your plan or update your Marketplace account between November 1, 2017 and December 15, 2017. It’s a good idea to update your account even if nothing in your household has changed because you may qualify for a higher premium tax credit that can help reduce your monthly premium.  

After December 15, 2017, you will not be able to enroll in or change a Marketplace health care plan unless you qualify for a Special Enrollment Period. Special Enrollment Periods become available if you lose qualifying health care coverage (like Medicaid, an employer health plan or COBRA), or have a change in the size of your taxable household (marriage, childbirth or adoption) or certain exceptional circumstances. To qualify for a Special Enrollment period, you must be able to prove that you meet the criteria, including having been enrolled in minimum essential coverage before your change occurred. You only have 60 days after your change occurs to take advantage of a Special Enrollment Period.

If you have considered allowing your plan premium to lapse and eventually become dis-enrolled, you may want to think again. By doing this, you will be required to pay the unpaid premiums in order to enroll in another plan from the same company. To avoid this; call your health care plan and cancel your insurance.

Lastly, in order to avoid unnecessary frustration with the enrollment process, Healthcare.gov will be down periodically for scheduled maintenance. Maintenance outages are regularly scheduled on Healthcare.gov every year during open enrollment. System downtime is planned for the lowest-traffic time periods and is necessary for the maintenance across federal agencies involved with open enrollment. These down times are generally scheduled for Wednesday, November 1, 2017 overnight, then on Sundays from 12:00 a.m. to 12:00 p.m., except on December 10, 2017.  

There are many trained staff in our area to help you understand, enroll or update your Marketplace account. You can access local help by visiting healthcare.gov and searching for local assistance.

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