UPDATED 10-16-17

Fall means open enrollment for your 2018 health insurance coverage. During open enrollment, you can enroll for the first time, re-evaluate the prices and services of your current plan, renew or change your health insurance regardless of what type of insurance you have.

Although the percentage of Arkansans with health insurance is higher than the national average, thanks to Medicaid expansion through the Arkansas Works Program, 7.9 percent of our neighbors still don’t have health coverage of any kind.

Here’s what you need to know to make this a quick and easy process. And, just by shopping, you could save money or get a plan that better meets your needs in 2018.

If there are insurance words or terms you’re not sure about (in italics in this article), look for them in the “Define your terms” section at the end of this article.

In Arkansas you can get health insurance from:

  • Your job or your spouse’s job (employer-sponsored insurance), or if you are younger than age 26, through your parent’s private insurance
  • The Affordable Care Act (ACA) or “Obamacare” (from the health insurance marketplace or healthcare.gov) is for people who do not have health insurance through a job, Medicare or Medicaid, or any other source that provides qualifying health coverage. Most people (80%) signing up for ACA insurance will receive a subsidy to help them pay the monthly premiums. If you have yearly income between $29,701 and $47,520, you will qualify for a subsidy. This subsidy is similar to the subsidies your employer would pay if you had employer-based insurance. Most people can find a policy for less than $100 a month.
  • Medicare, if age 65 or older and not working or you are disabled
  • Medicaid provides free or very-low-cost health services if you have a limited income. Arkansas’ Medicaid program includes the Arkansas Works program (funded by the Medicaid expansion under the ACA), traditional Medicaid for the medically frail, and ARKids First programs for children under age 19. Arkansas Works will pay most or all of the premiums for either a Qualified Health Plan or an Employer Sponsored Insurance (ESI) plan. You may be responsible for a small co-pay for doctor visits, medicines and some other medical services. You can choose the insurance plan that best meets your needs. And, if your family income is below 250 percent of the federal poverty level (FPL), this insurance will cover up to 95 percent of your health care costs. Subsidies are paid to the insurance company to enhance benefits for lower-income people.  All plans cover outpatient services, emergency room visits, hospital stays, prescription medicines, wellness visits, maternity and baby care, lab tests, and mental health and substance abuse services. All Arkansas Works Program recipients will be referred to the Arkansas Division of Workforce Services for free job assistance. You can apply on line at access.arkansas.gov. Or, call the Help Center at 1-855-372-1084.
  • UPDATE ON SUBSIDIES: The Trump Administration has announced an end to the subsidies that limit health care costs for lower-income people on Arkansas Works. The insurance companies have to honor this coverage through the end of 2017, so you will not see a difference in 2017. However, unless a court rules otherwise, you will likely have higher premiums in 2018 to make up for the loss of subsidies. To avoid higher premiums, insurance experts suggest you switch from a Silver level plan to a less expensive Bronze plan.

What’s open enrollment?

Open enrollment is the period of time that you can enroll or change your health insurance coverage. Be sure you meet the open enrollment deadline for your type of insurance.

  • Employer-based insurance – Most companies have a two- to four-week period in the fall when their workers can select or change health benefits for the following year. Check with your company’s human relations or benefits department for more details.
  • Private insurance from the marketplace/healthcare.com – Nov. 1 to Dec. 15, 2017 (You may still buy a health plan if you qualify for a Special Enrollment Period due to a life event such as birth of a child, moving, marriage or divorce.)
  • Medicare – Oct. 15 to Dec. 7, 2017 for sign-up or change your health and drug plans (Part D). If you are satisfied with your current plans, they will automatically renew for 2018. You have two options: Original Medicare or a Medicare Advantage plan. If you choose Original Medicare, you may also want to look at supplement plans or “Medigap” coverage. Medigap covers many of the costs that Medicare doesn’t pay, like copays and deductibles.
  • Medicaid/Arkansas Works/ARKids First – As soon as you become eligible, based on income and assets, you may enroll for Medicaid programs. There is no set enrollment period or deadline. People on the Arkansas Works Program can change plans during the open enrollment period.

Any new insurance coverage or changes you make during open enrollment will begin Jan. 1, 2018. But, you must complete your sign-up by Dec. 7 for Medicare or Dec. 15 for ACA subsidies.

2017 enrollment changes for ACA subsidies

ACA/marketplace enrollment changes for sign-up in 2017 include:

  • Shorter time to sign up – Nov. 1 to Dec. 15; last year you had until Jan 31
  • Coverage will start Jan. 1, 2018 if your sign-up is completed by Dec. 15
  • Fewer navigators to help you sign up, due to budget cuts
  • Reduction in ACA outreach/advertising budget – don’t wait until you see ads urging you to sign up because there probably won’t be any
  • The health insurance marketplace or “exchange” (healthcare.gov) will be off-line during open enrollment from midnight Saturdays to noon on Sundays
  • The subsidies that most people receive to purchase marketplace/”Obamacare” coverage remain uncertain, according to statements from the Trump Administration. The September subsidies were paid but the White House says it is reviewing this issue. Many insurance companies say this uncertainty has caused them to raise premiums or withdraw from participating in Obamacare in 2018.

Get ready to shop

There are several things to do before open enrollment starts.

  • Know your deadline to enroll or make changes.
  • Make sure the plan’s provider network includes your doctor, pharmacist, hospital and other services are included in your plan’s provider network. If you plan to visit a provider outside your plan’s network, understand what those costs will be; they’re almost certain to be higher than in-network providers. Also, be sure the plan’s formulary covers your medications because formularies change frequently.
  • Review your options. There’s no one best plan that fits everyone. Take time to evaluate how well your current plan met your health needs this year. You should have been notified if your policy’s benefits are changing for 2018. Call your policy’s administrator and ask about changes. Review your current plan’s costs and services and compare them to other options. This step can provide real savings; don’t skip it. Many people don’t take the time to look at their options – even when they can save money or get better benefits. When comparing costs, look at more than just the premium. Compare the deductible amount, co-pays, and the doctors and hospitals that are in your plan’s provider network. Some plans offer additional services such as vision and dental coverage or wellness plans.
  • If you’re on Medicare, there are several additional steps to review your options. Your current plan will mail you an Annual Notice of Change that explains how the plan is changing. For example, to decide if your prescription drug coverage/Plan D still meets your needs you’ll need to compare the medicines you take with the plan’s formulary. Gather all your pill bottles, or make a list of all your meds that includes name, what it’s for, dosage, what you pay for it, and how often/when you take it. Compare your list to the plan’s formulary for 2018 prices.
  • Marketplace coverage – visit this healthcare.gov website for a list of information you’ll need to have before you apply for ACA/marketplace coverage. You can find the most accurate information about the Marketplace at this site. You can also shop for plans, review costs and complete your application for a plan at healthcare.gov.

Eligibility requirements

Employer-based plans require you to be an employee. Some companies also cover your spouse and/or children. Children can stay on their parent’s insurance until age 26.

ACA/marketplace subsidies eligibility requires that you are not eligible for an employer-based plan (if you are working part-time or self-employed, for example), or qualify for Medicaid or Medicare.

Medicaid eligibility is based on your income and the value of your assets.

  • Arkansas Works coverage is extended to adults, ages 19-64, with incomes of up to 138 percent of the FPL – this year that’s $16,643 for one person; $33,948 for a family of four. Be advised that Arkansas has asked the federal government to allow the state to reduce Arkansas Works eligibility from 138 percent to 100 percent of the FPL. This will remove an estimated 60,000 Arkansans from Arkansas Works. Most of these people will receive federal subsidies to buy private coverage on the marketplace exchange. If the federal government grants this waiver, Arkansas Medicaid will notify you by mail if you are affected. Those who are effected will have a special 60-day special enrollment period to get insurance on the marketplace site.
  • Original Medicaid (for low-income, medically frail people) eligibility is explained at this website
  • ARKids First, parts A or B, provide health coverage for children ages birth to age 19. If children under age 19 live with you, they must be covered in order for you to be eligible for the Arkansas Works Program. If they do not have health care coverage, you should apply for ARKids for them.
  • ARKids First, Part B requires re-enrollment or renewal every year, within 12 months of the date you were first enrolled, unless the child moves out of state or turns age 19. After you’ve been enrolled for about 10 months, you’ll get a form from DHS. Fill it out and return to DHS to keep your insurance benefits. For more information about Parts A and B, visit this website or call toll free 1-888-474-8275 from 8 a.m. – 4:30 p.m. on weekdays.

If you apply for Arkansas Works and are told you’re not eligible because you make too much money, your application information is sent electronically to the federal health insurance marketplace. The Marketplace will tell you about other financial help or subsidies for which you qualify. It will be used to pay monthly premiums for regular health insurance. This valuable help is in the form of tax credits or reductions in premiums to help you purchase regular health insurance at www.healthcare.gov

Define your terms

Insurance can be complicated if you’re not familiar with the terms. Here’s a refresher:

Arkansas Works – formerly called the Private Option, uses federal funds earmarked for Medicaid expansion to buy private health insurance for Arkansans whose income is up to 138 percent of the federal poverty level (FPL). This may be reduced to 100 percent of the FPL in 2018 if the federal government approves a waiver from the state.

Co-payment co-pay or co-insurance – is a fixed amount that you have to pay, out of your own pocket, for a service. You pay co-pays at the time you receive the service.

Covered services, excluded services and annual limits on services – means the services your insurance policy will – or will not – pay for, or the amount of services you can receive in one year, in the case of annual limits on services.

Deductible – the amount you have to pay, out of your own pocket, before your insurance starts paying. Eighty/20 percent is common among insurance coverage and means you pay 20 percent of the costs (your deductible) before the insurance pays 80 percent.

Employer sponsored insurance (ESI) – the health insurance you get from your job. If this type of insurance is available to you and you do not enroll, you cannot enroll in the other types of insurance (ACA or Medicaid).

Formulary – a list of the medicines your health plan will cover. This list can change frequently and you may be required to use a generic version of your drug unless your doctor indicates brand name only.

Maximum annual out-of-pocket spending – a limit on what you have to pay out of your own pocket. If your health care costs exceed this amount, the insurance company starts paying 100 percent, after you have paid your deductible amount.

Medicare Advantage (MA) plans – also called Part C Medicare, are sold by private insurance companies to cover your Medicare parts A and B. Most of the plans also include Medicare supplement coverage and prescription drugs. This means you have only one premium to pay and don’t have to get a separate Part D plan and/or medigap plan. Some plans provide extra benefits like dental, vision or gym membership. However, MA plans cost more than Original Medicare.

Medicare supplement plans (or Medigap policies) – sold by private insurance companies and help pay some of the costs that Original Medicare doesn’t cover, such as copayments, coinsurance and deductibles.

Navigator – a trained person that can help you (at no cost) to evaluate your needs and find several good health insurance options from which to choose.

Penalty for not having health insurance – it will be 2.5 percent of your income this year.

Premium – the monthly, quarterly or annual amount you pay to have insurance. If you have insurance at your job, you may have your share of the premium deducted from every paycheck. People on Medicare typically pay their premiums quarterly and it is deducted from their Social Security check.

Provider network – includes the doctors, other health care providers and hospitals that an insurance plan has contracted with to provide medical care to its plan members.

Qualified Health Plan – a major medical insurance plan, certified by the federal government, that provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and covers all the mandatory benefits of the Affordable Care Act.

Subsidy – helps pay for health insurance in two ways. Advance premium tax credits subsidize lower premiums for people who buy insurance from the ACA health insurance marketplace, if their income is below 400 percent of the FPL (about $97,000 a year for a family of four). The average premium subsidy is about $386 a month (annually that’s a $4,600 savings). Most (80%) of people on ACA insurance get a subsidy. Your subsidy will be listed when you choose an ACA plan for 2018. The cost-sharing reduction payments reimburse insurance companies for increasing your benefits so your health expenses are covered up to 95 percent, if your income is below 250 percent of the FPL.

Visit this website for more health coverage and medical terms.

For more help:

ACA/marketplace coverage – go to this website for information about who can help you complete your application, including navigators, agents, brokers or certified application counselors. Do not pay for this service because it is available at no cost from trained and government-certified people.

Medicare – go to Medicare.gov or call toll free 1-800-MEDICARE. Local help to evaluate and choose your Part D drug plan is available from one of Arkansas’ eight Area Agencies on Aging (AAA). This help is free and objective. To find the AAA that serves the county you live in, go to this website. Go to page 4 for a list of the AAAs’ service areas, toll-free phone numbers and websites. Locate your county and call for a free appointment.

Medicaid – visit this website to apply.