Despite multiple attempts by a GOP-led Congress and President Donald Trump’s administration to repeal and replace Obamacare, formally known as the Affordable Care Act, over the past year, it remains the law of the land. In fact, Obamacare open enrollment begins this week, and its requirement that almost all Americans carry health insurance is still in effect.
There’s a lot of confusion out there about open enrollment season for Obamacare. After all, Trump recently decided to cut off important Obamacare subsidies paid to insurance companies to help lower out-of-pocket medical costs for low-income Americans. Trump has also signed executive orders scaling back certain requirements on insurance companies and essentially made enrollment outreach a non-priority by cutting off funding. The latter move has navigators who help people sign up for insurance coverage concerned that many will neglect to take advantage of open enrollment out of uncertainty or because they simply don’t know Obamacare is even around anymore; a new analysis by S&P Global Market Intelligence finds Trump’s moves may lead to 1.6 million fewer Americans signing up for individual health insurance plans in 2018 compared to 2017.
Here are some of the most important things to know about Obamacare open enrollment for 2018 in this tumultuous time.
What is health insurance open enrollment?
Open enrollment is a period during which people can buy health insurance coverage for the upcoming year. The reason that there’s a set amount of time each year for open enrollment is a socioeconomic one: It’s to prevent people from only buying insurance when they’re sick. This way, health plan holders have coverage throughout the year (provided that they pay their monthly insurance premiums) and insurers don’t have to worry about only receiving someone’s premiums when they develop a more costly medical need.
When is open enrollment for Obamacare 2018?
The 2018 Obamacare open enrollment season runs from Wednesday, Nov. 1 through Dec. 15. That’s a shorter open enrollment period than in previous years. Open enrollment for other kinds of insurance, like health plans offered by your employer, may be different. For instance, those may occur during the last two weeks of October or another designated period worked out by the employer and health insurers whose plans they offer.
Former President Barack Obama took to Twitter to remind social media users about the enrollment season Wednesday.
How do you sign up for Obamacare?
If you don’t have insurance coverage through your employer or a public health insurance program like Medicare or Medicaid (as the vast majority of Americans do), you can sign up for private individual health insurance plans on Obamacare’s marketplaces through Healthcare.gov. (Some states manage their own Obamacare marketplaces rather than using Healthcare.gov, but you can get to those through the federal site, too).
It’s possible to sign up for private Obamacare plans outside of this open enrollment period under certain special circumstances, like if you lose your job, move, or get married. Americans with low enough incomes to qualify for Medicaid (which was significantly expanded in many states under Obamacare) can enroll in that program at any time of the year.
Obamacare coverage for 2018 purchased during the open enrollment period kicks in on January 1, 2018.
When is the deadline for Obamacare open enrollment?
The deadline for Obamacare enrollment is December 15 in most states. However, some states which run their own Obamacare marketplaces may choose to extend their deadlines in order to allow more people to sign up (many have chosen to do this in the past). Check your state’s Department of Health’s website to figure out whether or not you have some extra time to sign up for health insurance coverage.
Obamacare premiums increase in 2018
You’ve probably heard that Obamacare premiums are on the rise. This is true, for a variety of reasons—but that doesn’t mean you’ll necessarily have to pay more money.
People earning between 100% and 400% of the Federal Poverty Level (FPL) qualify for federal tax credits which help them pay their monthly health insurance premiums for private Obamacare plans. The less your income, the more generous the tax credit. In some cases, depending on how generous the kind of plan you buy is—basic catastrophic coverage, Bronze, Silver, Gold, or Platinum—and your income, you may actually be able to get a plan for no money at all, as the nonprofit Kaiser Family Foundation’s Larry Levitt explains.
Plans with lower premiums also tend to come with higher deductibles and yearly out-of-pocket maximums.
Ironically, federal subsidies have actually become more generous for Obamacare plans this year because of Trump’s decision to cut off the other kind of Obamacare subsidies—the ones made to insurance companies rather than consumers and which the president has dubbed an insurance company “bailout.” Those payments to health insurers are doled out in exchange for the firms lowering the out-of-pocket costs paid by individuals or families who opt for a mid-level “Silver” Obamacare plan and earn up to 250% of the Federal Poverty Level.
The thing is, insurance companies still have to offer that financial benefit to qualifying Obamacare customers whether or not Trump makes the payments. And many had already assumed he would follow through on the threat to end the subsidies. So, in preparation for that, many participating Obamacare insurers proactively raised certain Silver plan premiums for 2018. And since the level of federal tax credit subsidies to help consumers pay their premiums is based on the average cost of “benchmark” Silver plans, that actually means 2018 Obamacare customers who qualify for assistance will receive more generous health premium subsidies. However, Americans who make too much money to be eligible for the subsidies and buy individual insurance will have to swallow those increases.
The moral of the story: If you’re looking for a private individual health insurance plan during this Obamacare open enrollment season, make sure to shop around.
Our updated Insider’s Guide to Obamacare’s Open Enrollment offers time-saving strategies for selecting coverage during open enrollment. (Click the image for the latest edition.)
Q. What is the deadline to enroll in health insurance coverage in the individual market?
A. Open enrollment for 2018 coverage was much shorter than the enrollment window was in previous years, and the shorter enrollment window will continue to be used in future years. It began on November 1, 2017, and in most states, it ended on December 15, 2017. In most states, all plans took effect January 1, 2018; there is no longer an option to switch to a different plan after the first of the year.
Outside of open enrollment, plan changes and new enrollments are only possible for people who experience a qualifying event. But as noted below, there were quite a few extensions and special enrollment periods that allowed many people to enroll well after mid-December.
Originally, open enrollment for 2018 coverage was scheduled to follow the same three-month time frame that the past two open enrollments used (November through January). But in April 2017, HHS finalized a market stabilization rule that includes a variety of changes ostensibly aimed at protecting the stability of the individual health insurance market.
One of the changes made by the new rule was the open enrollment schedule for 2018 coverage. It was reduced to half of what was previously scheduled, although it’s worth noting that the November 1 — December 15 schedule was already slated to take effect in the fall of 2018 (for 2019 coverage). The market stabilization rule just moved it up a year. However, the Trump Administration also drastically reduced funding for outreach, marketing, and enrollment assistance for HealthCare.gov, which is the exchange used by the majority of the states. This was certainly not what the previous administration had in mind when they scheduled the transition to a shorter open enrollment period. If anything, the shorter enrollment period requires more funding, not less.
The open enrollment window applies in the exchanges, and it also applies to plans purchased outside the exchange—with the exception of Nevada. (In Nevada, off-exchange plans—with no subsidies—can be purchased year-round, but the carriers can impose a three-month waiting period before coverage takes effect.)
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State-run exchanges had some flexibility on open enrollment for 2018
The market stabilization rule noted that the November 1 — December 15 open enrollment period would apply in every state in the fall of 2017. However, they also noted that some state-based exchanges — there are 12 of them — might experience logistical difficulties in getting their systems ready for the new schedule on a fairly tight timeframe (the rule was finalized in April, and open enrollment began less than seven months later).
As such, the market stabilization rule clarified that state-based exchanges could use their own flexibility to “supplement the open enrollment period with a special enrollment period, as a transitional measure, to account for those operational difficulties.” Ten of the 12 state-based exchanges that use their own enrollment platform ultimately opted to extend open enrollment:
- Connecticut’s exchange allowed people to enroll until December 22, for coverage effective January 1.
- Maryland‘s exchange allowed enrollments until December 22, for coverage effective January 1. Unlike the other exchanges that planned their extensions well in advance of open enrollment, this was a last-minute announcement.
- Rhode Island’s exchange allowed people to enroll until December 31, for coverage effective January 1
- Colorado allowed people to enroll until January 12. Enrollments completed between December 16 and January 12 had coverage effective February 1.
- Minnesota‘s state-run exchange, MNsure, announced on August 1 that Minnesota residents would have until January 14 to select a plan for 2018. MNsure also extended the deadline for a January 1 effective date: residents who enrolled by December 20 had coverage effective January 1, 2018.
- Washington’s exchangeallowed enrollments until January 15, 2018, although they encouraged residents to sign up by December 15 so that they could have a January 1 effective date.
- Massachusetts‘ exchange continued open enrollment through January 23, 2018. In Massachusetts, enrollments can always be submitted by the 23rd of the month for a first of the following month effective date (Rhode Island is the only other state that normally does this; in every other state, the deadline is the 15th). So people in Massachusetts who enrolled by December 23 had coverage effective January 1. Those who enrolled between December 24 and January 23 had coverage effective February 1.
- DC‘s exchange initially extended open enrollment until until January 31, 2018, but they made another last-minute extension through February 5, 2018, making theirs the longest open enrollment period in the country.
- California‘s exchange also retained the originally scheduled open enrollment dates for 2018 coverage, with enrollment continuing until January 31, 2018. Covered California allowed residents to enroll until December 22 for coverage effective January 1, and they announced on January 31 that people who began the enrollment process by midnight on January 31 would have until February 2 to finish the enrollment process.
- New York‘s exchangeannounced in early September that their open enrollment period would run from November 1, 2017 through January 31, 2018 — the full three months that was originally scheduled before CMS changed the dates in April.
In most of those states, the normal effective date rules applied, so enrollments had to be completed by December 15 in order to get a January 1 effective date, and enrollments completed after that date resulted in coverage effective in February or March. But six of the state-run exchanges implemented enrollment deadlines after December 15 for people who wanted January 2018 coverage.
Only state-run exchanges that use their own enrollment platform had flexibility in terms of the dates for open enrollment for 2018 coverage. There are 12 such states, and as noted above, ten extended their open enrollment periods. But the exchanges in Idaho and Vermont ended open enrollment on December 15, 2017.
Outside of the open enrollment window, enrollment is only available with a qualifying event
After open enrollment ended on December 15, 2017 (or later, if you’re in one of the states with an extended deadline), people can only purchase coverage for 2018 if they have a special enrollment period triggered by a qualifying event such as:
There was also an exceptional circumstances special enrollment period through December 31, 2017 for people in areas that were hit hardest by the 2017 hurricane season and the windstorms that affected much of Maine. The special enrollment period applied to residents of five full states, three partial states, and anyone who had lived in the US Virgin Islands or Puerto Rico during the hurricanes.
Regardless of whether you purchase insurance through the exchange or off-exchange, the annual open enrollment window applies, and special enrollment periods are necessary in order to enroll at any other time of the year. Nevada is an exception – coverage is available there outside the exchange year-round, albeit without subsidies and with a 90-day waiting period before coverage becomes effective.
In 2016, HHS tightened up the rules regarding eligibility for special enrollment periods, and they further tightened the rules in 2017, as part of the market stabilization rule. As a result, the rules are being followed much more closely than they were in previous years, and in most states, anyone enrolling during a special enrollment period is required to provide proof of the qualifying event that they experienced
Native Americans and Alaska Natives can enroll year-round. Applicants who are eligible for Medicaid can also enroll year-round.
Special rule for loss of coverage
If you had a health plan that was terminated on December 31 for reasons other than non-payment of premium or fraud, you are eligible for a special enrollment period, as loss of coverage is a qualifying event. In order to take advantage of this provision, you’ll need to check the box on the application that says you’re enrolling because you lost coverage.
Here’s more about how the loss of coverage qualifying event works.
There are at least 19 insurers across the country, some of which offer plans in several states, that exited the exchanges or the entire individual market at the end of 2017.
- People who had on-exchange coverage with these plans were mapped to plans with different insurers if they didn’t return to the exchange to pick a new plan by December 15. But they’re still eligible for a special enrollment period (which continues through March 1, 2018) during which they can return to the exchange and pick a different plan.
- People who had off-exchange coverage with these plans generally became uninsured as of January 1 if they didn’t pick a new plan for themselves, as there’s no entity available to automatically select a new plan for them. But the same special enrollment period applies to off-exchange enrollees — they have until March 1, 2018, to sign up for a new plan (albeit with a gap in coverage if they didn’t sign up by December 31, as the earliest available effective date after that point was February 1).
Limited enrollment windows are normal and necessary when coverage doesn’t depend on your medical history
We frequently see people lamenting the fact that there’s a limited window in which to purchase coverage, but there are a couple points to keep in mind:
- Limited open enrollment periods have long been the norm for employer-sponsored health insurance, which is where most non-elderly Americans get their coverage (you can’t just enroll in your employer’s plan anytime you like; you have to wait for open enrollment, unless you have a qualifying event).
- Medicare also has limited annual open enrollment periods.
- The individual health insurance market used to allow people to purchase coverage any time they wanted. But the insurance company would ask a long list of medical history questions, and would decline applications from people with serious pre-existing conditions. That’s no longer the case, so the limited enrollment window is necessary to prevent people from waiting until they’re sick to enroll (which would be unsustainable, since insurance only works if there are enough healthy people paying premiums to offset the costs of the sick people).
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Shorter open enrollment is controversial
The reason the open enrollment period was shortened was to ensure that as many people as possible are enrolled in coverage for the full year. In the past, open enrollment continued throughout January (or even later, in the case of the initial open enrollment periods), which meant that people could sign up near the end of open enrollment and get a plan that took effect in March.
The idea behind the new schedule is that everyone has coverage that starts in January, making people more likely to pay for a full year of coverage. The new schedule also removes the ability for people to “game the system” by signing up in November for an expensive plan, utilizing it for a planned expense (a surgery, for example) in January, and then switching to a lower-cost plan with an effective date in February or March. It also eliminates the adverse selection that would otherwise occur when people don’t plan to enroll but then find out in late December or January that they’re in need of health care.
But on the other side of the coin, there has been considerable concern among consumer advocates, brokers, and other enrollment assisters who worry that six weeks just isn’t enough time to help everyone get enrolled. The new open enrollment period mostly overlaps with open enrollment for Medicare Advantage and Medicare Part D, and many of the brokers who help people enroll in individual market plans are also helping people enroll in Medicare during the same time, stretching their resources.
There have also been concerns that the shorter open enrollment period might mean that fewer young, healthy people will enroll in individual market coverage. Sick people tend to enroll as soon as open enrollment begins, so they’ll enroll regardless of the schedule. But young, healthy people — the people who are needed in order to keep the risk pools stable — are more likely to procrastinate and enroll at the last minute. The shorter open enrollment period might mean that they just don’t enroll at all, with total enrollment ending up lower than it would have been with the longer enrollment period.
But despite the shorter enrollment period and the funding cuts that the Trump Administration made for marketing and enrollment assistance, enrollment in plans for 2018 was only slightly lower than it had been the year before. Almost 11.8 million people enrolled in exchange plans for 2018, versus about 12.2 million for 2017.