It’s time to enroll (or re-enroll) for people who must buy health insurance from the health insurance Marketplace, also called the state Exchange. During open enrollment, you can enroll for the first time, renew your current coverage, re-evaluate plans’ prices and services, and either renew your current plan or choose a different plan. Open enrollment runs through Dec. 15. Go to HealthCare.gov. or myARInsusrance.com. This article can help you through this important decision-making process.
Sign up before Dec. 15
You must sign up before Dec. 15 for your health insurance coverage to begin Jan. 1, 2019. If you don’t sign up before 11:59 p.m. on Dec. 15, 2018, you will not be able to sign up for a Marketplace health plans until Nov. 1, 2019, a full year from now. Once you sign up with a plan, you must stay with that plan for 12 months, or until the next open enrollment period.
However, if you had certain changes in your life during the year, you have a special 60-day period to enroll in Marketplace health plans, outside of the open enrollment period. These changes include losing your health insurance, job changes, marriage or divorce/legal separation, gaining or losing a dependent, moving or losing COBRA coverage. If you find you cannot afford COBRA coverage from a previous job, you can sign up for Marketplace coverage and drop your COBRA coverage AFTER your new Marketplace coverage begins.
If you get your health insurance from your employer, or Medicaid, Medicare, Tri-Care or Arkansas Works (formerly the Private Option), you don’t need to go to the Marketplace. However, if you are not eligible for any health insurance through a group, such as your employer or Medicaid, you must buy individual, non-group health insurance from the health insurance Marketplace.
Compare plans and update your subsidy
All plans available in Arkansas are listed on the Marketplace website. It is easy to compare several plans by price, services and benefits offered. Most people will qualify for a subsidy. The website will show the full cost of the plan, any cost-sharing or premium tax credits you’re eligible for and what your monthly premium will be. If you choose to receive an advance premium tax credit, it will be deducted from your monthly premiums. You also have the option of paying the premiums yourself and then filing for your tax credit when you file your income tax return. The amount of your premium tax credit depends on your income and the cost of Marketplace health plans in your area.
These tax credit subsidies make it possible for middle-income families to afford health insurance. This subsidy is like the subsidy an employer would pay if you had employer-based insurance. Most people shopping on the Marketplace get a subsidy to make premiums affordable.
People with very low income can find out at the Marketplace if they are eligible for health insurance through Medicaid or ARKids First (CHIP) coverage. If you are eligible, you can enroll for Medicaid or ARKids First at any time during the year.
How do I enroll?
- On any device that connects to the internet, go to HealthCare.gov. or, in Arkansas you can use My Arkansas Insurance.com. You can compare plans and sign up at this website.
- Even if you are happy with your health insurance this year, always review all your options for 2019. Insurance plans usually change from year to year, and your personal or family health needs can change. You may find a better price or a policy that better meets your 2019 health needs.
- You must reapply for your subsidy every year because it is based on your income during the past year.
- If you need help comparing plans and/or enrolling, a navigator can help you. Marketplaces are required to make navigators available to help you complete the plan’s application and apply for financial help, including help applying for Medicaid or CHIP. Navigators are paid by the Marketplace and must complete Marketplace training and be free from conflicts of interest. They do not work for individual health insurance companies.
- In addition to navigators, volunteer assister programs may be available at community health centers, hospitals or other non-profit groups.
- Private insurance brokers can also help. They also complete Marketplace training but are paid commissions by health insurance companies for each policy they sell.
What are my options?
Marketplace health plans cover different services, offer different cost-sharing amounts (co-pays and deductibles) and have different monthly premiums. However, all health plans offered through the Marketplace must meet the Affordable Care Act’s requirements of “qualified health plans.” This means they are required to cover the 10 essential health benefits, limit the amount of cost sharing such as deductibles and co-pays, and have no restrictions for pre-existing conditions or lifetime limits on coverage. You cannot be charged more or turned down for coverage because of your health status or a pre-existing condition.
Types of plans: All the plans are grouped into four categories. They are labeled as Bronze, Silver, Gold or Platinum to indicate the amount of cost sharing they require and their network of providers and hospitals. Bronze plans have the highest deductibles (the amount you pay out-of-pocket before the insurance starts paying) and other cost sharing such as co-pays to your doctor. Platinum plans have the lowest deductibles and co-pays. Silver and Gold plans have medium cost sharing. Generally, plans with lower cost sharing have higher premiums and vice versa.
Review the plan summary: All plans must provide a simple-to-understand Summary of Benefits and Coverage. Focus on this summary when comparing plans. If you ask the Marketplace website to do a side-by-side comparison of plans, they use these summaries.
Look at the plan’s network. Plans must include a link to a list of providers and hospitals that are in their network. Using providers in the plan’s network will save you money. Most plans let you get care outside their network, but it usually costs more. Be sure to check if the doctors, pharmacists, hospitals and other providers you prefer are in the plan’s network.
Will they cover my medications? Be sure to look at your plan’s link to the prescription medications they cover (called a drug formulary). If your medications are not listed, the plan does not have to pay for them. If your doctor says they are medically necessary, you may appeal for an exception to the plan’s formulary. However, there are no guarantees they’ll pay for it.
I’m happy with this year’s plan. Do I have to renew?
No, but if you don’t renew by Dec. 15, the Marketplace will automatically renew the same plan for you. If that plan is no longer offered, they will renew you with a similar plan. If you want a different plan, you must do some comparison shopping before Dec. 15.
Most plans make changes every year in the services they cover and premiums. You should have already received a notice from your current insurance company describing any changes they have made to your policy for 2019 and the new monthly premium. Smart consumers always review their options to be sure they have the best plan, at the best price.
Update your subsidy
During open enrollment, it’s very important to update your income and family information. This ensures that your premium tax credit will be calculated correctly.
If your income is between 100 to 400 percent of the federal poverty level, you will receive a subsidy to reduce the cost of your monthly premiums. The premium tax credit can only be used to pay for a Marketplace plan. If you prefer an advance premium tax credit, the government will pay the credit directly to your insurance company. Your insurance company will bill you for the rest of the premium. Your other option is to pay the full premium yourself and then claim the full tax credit at the end of the year when you file your income tax return. Always report any changes in your income during the year to the Marketplace, so your credit can be adjusted. This helps you avoid any significant repayments when you file your income taxes.
In addition to the premium tax credit, if your income is between 100 and 250 percent of the federal poverty level, you can also qualify for cost-sharing reductions. These will reduce the deductibles, copays and other cost sharing that would otherwise apply to covered services. Cost-sharing reductions are available through modified versions of the marketplace’s Silver plans. Once the Marketplace determines you are eligible for cost sharing reductions, you will be able to select one of these modified Silver plans, based on your income level.
For more information, visit the Kaiser Family Foundation website for an extensive list of answers to frequently asked questions here.