Affordable Care Act (ACA) Open Enrollment 2019

As open enrollment for 2019 approaches, you may be feeling confused about what has and has not changed. First introduced under President Barack Obama in 2013, the Affordable Care Act (ACA) still has many of the original components that it had originally. This year, open enrollment runs from November 1 to December 15.

Unchanged Items for the Upcoming Open Enrollment Season

When you choose your health coverage during open enrollment this year, it will look much the same as it did in 2017. This includes the following:

  • ACA Exchanges: You still have the option to shop for health insurance coverage in either a state or federally funded marketplace. This gives you the opportunity to compare several different plans before enrolling in one. Depending on your income, you may be able to apply for state or federal subsidies to help pay for the cost of health insurance coverage. You can also shop for your coverage with an off-exchange individual major medical plan, although you would be ineligible for a subsidy if you choose this option.
  • Individual Mandate: Although the mandate to purchase health insurance remains, the penalty for not doing so goes away this year. You may also hear this referred to as the shared responsibility provision.

Changes to Anticipate in the Future

In June 2018, the Centers for Medicare and Medicaid Services (CMS), released a Final Rule for the upcoming open enrollment season and the seasons beyond it. As mentioned above, the only thing you will notice different this year is the elimination of the tax penalty for not carrying a minimum amount of health insurance. By 2020, the Trump administration wants to give states greater flexibility in offering plans as well as change some of the Essential Health Benefits (EHB) states must offer to meet ACA regulations.

Currently, all marketplace plans must offer 10 EHB that the federal government dictates. Over the next few years, states will have the freedom to choose their own EBHs for any benchmark plans offered. They can choose from among 50 EBHs that other states used for benchmark plans in 2017. The goal is to spur insurance carriers to become more creative and competitive with their policies to give healthcare consumers more options.

If you plan to apply for a tax credit in future years, you should expect a greater burden to prove that you qualify for one. Additionally, the new rule on tax credits will make people ineligible if they fail to file a tax return or reconcile any advanced premium tax credits (APTC) from prior years.

The Trump administration will also loosen the Medical Loss Ratio (MLR) for insurers. The MLR is the percentage of revenue that an insurance company spends on claims as compared to its overhead. In the past, health insurance providers had to meet a minimum MLR score of 80 percent. By lowering the score requirement, the current administration hopes to drive down health insurance costs because it frees more companies to enter the marketplace. Under the Final Rule, insurers no longer need to provide written justification for rate increases greater than 10 percent. It will jump to 15 percent in 2019.

Perhaps most importantly for those who rely on the open marketplace for health insurance coverage, insurers still can’t deny applicants with pre-existing health conditions.

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