If you have been planning to renew or enroll in a health insurance marketplace plan through the Affordable Care Act (ACA) in 2017, nothing about the recent elections should change your plans. In fact, as of Thursday, December 1st more than 2.1 million people have signed up for 2017 coverage, with just over 300,000 of those signing up since the election. The Obama administration and health related federal agencies are moving forward with planning for 2018, which illustrates a commitment to the ACA and the marketplace. You should shop for a plan now. The ACA is current law and in general, insurers participating on healthcare.gov are required by federal and state law to continue providing coverage through the end of 2017. So, it’s important to select the plan that is right for you and your family now.
However, it is clear that changes are on the horizon for the ACA. Here are some important facts regarding the upcoming transition:
- Congress will have to pass a law to make major changes to the law. Senate Democrats will have enough votes to sustain a filibuster that could block a full repeal of the ACA.
- As a result of this, it is likely that Congress will use a budget reconciliation approach in the near term to make changes to the ACA. All provisions of reconciliation bills must relate to government spending or revenues, so only those aspects of the ACA may be included in the bill. So, eliminating premium tax credits or subsidies could be included, but not a repeal of the elimination of the pre-existing conditions exclusion. The benefit for consumers is that this type of legislation cannot be filibustered.
- Most experts expect that even if parts of the law are repealed in 2017, the changes will be phased in over a few years to give policymakers time to draft, enact and implement a replacement plan.
- Will ACA change in the future? Yes, we are certain there will be changes, but we can be just as certain they won’t happen overnight. The ACA was signed into law in 2010, but has yet to roll out in its entirety. It is continually being refined to reflect changes in the insurance market and the needs of consumers.
- The National Hemophilia Foundation has worked tirelessly over the decades to help promote and shape legislation that ensures our community’s access to care is protected. Further, we are more committed than ever to continue to make our voices heard.
OPEN ENROLLMENT PERIOD
The healthcare marketplace open enrollment period for 2017 is November 1, 2016 to January 31, 2017. The following dates are important to note:
- November 1, 2016: Open enrollment started; first day to enroll, re-enroll or change a 2017 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as January 1, 2017.
- December 15, 2016: Last day to enroll in or change plans for coverage to start January 1, 2017.
- January 1, 2017: 2017 coverage starts for those who enroll in a plan or change plans by December 15, 2016.
- January 31, 2017: Last day to enroll in or change a 2017 health plan. After this date, you may only enroll in or change plans if you qualify for a Special Enrollment Period.
Remember, if you are currently enrolled in a marketplace plan YOU WILL BE automatically re-enrolled. However, NHF recommends looking at your plan carefully and seeing if there might be a more suitable option available that provides broader coverage and is possibly less expensive.
In addition, if your income has changed, you may qualify for tax credits, reduced cost-sharing subsidies or Medicaid. So, if your income is less than 400% of the federal poverty level, or FPL ($47,520 for a household of one) you could qualify for a monthly premium tax credit, which will lower the premium amount. If your income is less than 250% of the FPL ($29,700 for a household of one) you could be eligible for cost-sharing subsidies, which will limit your maximum out-of-pocket costs. It is important to note that to qualify for the subsidies you must be enrolled in a silver plan. Qualifying for Medicaid is determined based on your income and whether your state has expanded the program.
If you need help in enrolling or re-enrolling in a plan, there are several resources available. Those include your hemophilia treatment center (HTC) support staff or in-person certified navigators located throughout the US. (Navigators can be found on healthcare.gov or your state-based marketplace websites.) While no one should make the decision for you, they can help you navigate the complicated language that many plans use.
It is important to remember: now is the time of year for many plans to change. Even if you aren’t enrolled in in a marketplace plan, you should be sure to thoroughly read both your current insurance policy and any correspondences you receive from your insurance company. This can help you determine whether there may be changes in your drug formulary or your provider networks for 2017.
The good news is that that many of the consumer protections included in the ACA also apply to the plans outside the marketplace (e.g., employer-sponsored and non-marketplace plans). Read “Insurance Plan Changes–Now What”, which provides examples of some wording commonly used in letters from your insurance carrier when outlining plan changes. To view information on what consumer protections apply to plans purchased through your employer or on the individual market, please view the factsheet section of NHF’s Personal Health Insurance Toolkit.
For the bleeding disorders community, making insurance coverage decisions during the open enrollment period can be one of the most important decisions you make all year! So, while going through the process may seem time-consuming and cumbersome, remember: making the right decision may result in lower out-of-pocket costs, broader coverage and minimizing the stress often associated with obtaining the care you need.
