ACA Open Enrollment Ends Jan. 31
November 1, 2016 - January 31, 2017 - Are you ready?
The Open Enrollment period for 2017 ACA Marketplace health insurance is November 1, 2016 to January 31, 2017. Critical deadlines are:
November 1, 2016: Open Enrollment begins. Apply for or change your coverage.
December 15, 2016: Deadline in order to have coverage that begins on January 1, 2017 (if you apply on December 16, your coverage will most likely not start until February 1).
December 31, 2016: Coverage ends for 2015 plans. You will be auto-renewed if you don’t change your plan.
January 31, 2017: This is the last day you can apply for 2017 coverage before the end of Open Enrollment.
If you miss this window you cannot enroll until the Marketplace re-opens in November 2017 unless you have a special “life event” such as having a baby or losing your job. This is designed to prevent people from taking advantage of the system by enrolling and dropping insurance multiple times a year when they only get sick.
If you don’t enroll in Obamacare in 2017, you’ll be fined 2.5% of your income or $695 per adult, whichever is higher (Note: this is estimated. Official totals have yet to be announced for 2017 and will increase based on inflation).
Individuals and children living in poverty can enroll at any time in Medicaid or the Children’s Health Insurance Program (CHIP). There is no enrollment period for these programs, but there are income restrictions and other qualifiers.
Coverage start dates
If you enroll before the 15th of any month, your coverage starts the first day of the next month. If you enroll after the 15th of the month, you’ll have to wait until the month after that for your coverage to start. So, for example, if you enroll on January 16, your coverage would start on March 1.
Don’t Be Blindsided: 2017 Comes with Changes
Marketplace enrollees may discover that their health coverage for 2017 differs dramatically from their 2016 plans. An estimated 2 million people who enroll using state and federal health insurance exchange sites will be forced to choose new coverage for next year. This is due to several major and minor insurance providers dropping out of the exchanges. United Healthcare, Humana and Aetna — three major national insurers — have already announced that they will not be participating in many or all of the markets where they currently offer coverage. In some states, smaller issuers have also dropped out, citing financial loss as the primary motivator.
Under the Affordable Care Act, consumers have the option to let their health plans “auto renew,” which essentially means that a person’s health insurance coverage will simply renew each year unless changes are made. During open enrollment each year, enrollees can also make changes or sign up for a new health plan altogether.
Unfortunately, many consumers allow their plans to renew automatically. Auto renewal can be a risky option since health plans change from year to year. In a competitive marketplace, health insurers offer newer plans with better features. Consumers who shop for coverage are more likely to find a better deal in terms of plan benefits and monthly premiums. For 2017, shopping for coverage is not only beneficial but essential for some consumers. With several major providers bowing out of the marketplaces, enrollees could find themselves forced into different plans, a situation known as “health plan mapping.”
Plan mapping occurs when a carrier moves an enrollee to a similar plan because the person’s current plan has been discontinued. It’s not a new practice, but it has become more common thanks to the competitive nature of a post-ACA insurance market. When carriers innovate or update their plans from year to year, they simply map enrollees to a similar policy if those enrollees allow their plans to auto renew.
The practice itself isn’t necessarily a bad thing, but for some consumers, plan mapping may mean a higher monthly premium, a narrower network or different health care options. Next year, the marketplace may look very different due to the absence of major insurers like Aetna and United Healthcare. People who have plans with insurers that have cut ties with the exchange sites will be forced to choose a new policy — or have it chosen for them.
Under the Notice of Benefit and Payment Parameters for 2017 issued by the Department of Health and Human Services (HHS), the exchange sites will determine health insurance coverage for anyone whose plan no longer exists provided that the enrollee doesn’t come back to the site to select a plan. In other words, if you have a plan with one of the carriers that isn’t participating in the exchanges and you don’t choose a new plan during open enrollment, then the exchange site will choose one for you.
The wording used by the HHS makes it clear that the exchange site will do its best to find similar health plans, but this is no guarantee that a consumer will have comparable coverage — or a comparable monthly premium. In some instances, enrollees may be mapped onto different carriers entirely, which could impact network and availability. Prior to 2017, mapping consumers onto a different carrier was not allowed. This has changed for next year.
ACASignUps.net estimates that about 2 million exchange enrollees will be affected by insurer dropouts in 2017, most of whom have plans with United Healthcare and Aetna. Open enrollment begins Nov. 1 and runs through Jan. 31, 2017. Shopping for a new plan can result in lower premiums or better features. Consumers are encouraged to check the status of their health plans and browse for new coverage next year.
Obamacare and the Campaign Trail: Trump vs. Clinton
Republican presidential nominee Donald Trump said he would dismantle the whole system and both the industry and its providers would no longer have to abide by the laws regulations. Without the Affordable Care Act, there would also be no individual mandate to require every American to have insurance coverage. After repealing the law, Trump intends to boost competition of insurers by allowing them to sell products across state lines, create more Health Savings Account options, and use block grants to fund state-run Medicaid programs. Trump healthcare and Clinton healthcare are at opposite ends of the spectrum.
Trumpcare would immediately call for a repeal of the Affordable Care Act (ACA), removing the individual mandate and stopping the expansion of Medicaid program eligibility. Millions of people would become uninsured and there would be an economic penalty to pay until a solid replacement plan is put in force. Without regulations in place, quality and availability of insurance plans for those who could continue to afford them would also be impacted. Federal funding to states, communities, and providers would also be altered or withdrawn. Insurers would be caught in a situation of losing an estimated 12.3 million policyholders and have to offset predicted gains of 56 percent since 2010 along with anticipated losses of 25 percent for those who no longer have to carry insurance. They would do this through expected increased pricing, layoffs, consolidation, and even bankruptcy for less prepared companies. Those left would have to absorb the additional members and costs, increasing their financial burdens temporarily. Those still insured in the marketplace would see roughly an 8 percent increase in premiums.
Trump believes the market forces in the health care industry can absorb the changes through premium tax deductions and increased use of tax-free health savings accounts (HSA) limiting costs and need for private insurance coverage. Insurance companies would design new products and premiums. In addition, HSA funds would transfer to heirs without a tax penalty.
In an effort to promote free enterprise, Trump would also allow the sale of health insurance across state lines and shift Medicaid from federal to state control. However, he would not require insurance companies to develop and sell products to every state or every population. It would naturally increase competition and decrease costs, possibly allowing smaller insurance providers to compete with larger ones. People would be able to comparison shop for prices on coverage, procedures, and exams. Because the insurance industry is also part of the banking and finance industry, there does seem to be a need for Federal regulations, but Trump has not addressed them. This goes against his general philosophy of government interference and reducing the country’s dependence on public health programs. He would need to have Congress repeal the McCarran-Ferguson Act passed by Congress in 1945 taking back the power for states to regulate insurance companies.
Trump believes Medicare should be able to negotiate drug pricing and save $300 billion a year by allowing the purchase of drugs overseas. He wants to rework the Medicaid system somehow and still be able to provide coverage to those with pre-existing conditions, but on both those initiatives, he is unclear about the process or direction he would take.
He believes the illegal immigrant population has put the U.S. health care system under duress and, by restricting visas, he can reduce health care costs to state and local governments.
Trump repeals the Affordable Care Act in order to base a health care system on a free market economy designed to balance supply and demand, automatically decreasing costs to a reasonable level, insisting that the best social program is maintaining employment and reducing dependence on public assistance. Repealing Obamacare deregulates the health care industry once again, block grants for Medicaid give states a specific budget to control, Medicare can negotiate lower drug costs, and everyone has a choice to participate in coverage or not. Election coverage for Trump’s health care provisions are certain to be vastly different than Hillary Clinton’s health care plans.
Democratic presidential nominee Hillary Clinton said she will continue to expand the current Obamacare coverage because she believes in the results. She believes the ACA law is directly responsible for 16 million additionally insured people, many of whom are young, have pre-existing conditions, and are women who were not receiving the coverage or care they deserved.
To achieve her goals, it requires more government influence to oversee processes in the health insurance industry and medical facilities in order to maintain compliance with the laws, greater stimulus for services to continue the growth of the Medicare Advantage and Medicaid programs, and a move toward centralization of services similar to a singlepayer system.
Clinton will continue to enforce the existing law requiring health insurers to disclose costs of medical services, claims payment processes, and quality data to consumers. She will block or modify health insurance rate increases if they are found to be unreasonable. Clinton talks about tax credits of up to $5,000 per family intended to offset some of the excessive out-ofpocket and premium costs if they go above 5% of their income. This is in addition to ensuring that families buying health care coverage on the exchange will not have to pay more than 8.5% of their household income for premiums.
She extends these out-of-pocket costs and premium restrictions to include the family glitch created when employers’ coverage exceeds the cost of health care marketplace coverage. Further, she includes three sick visits a year without having to meet a deductible. She is very aware that deductibles have tripled in the last 10 years while copays have continued to rise and proposes to reduce these costs. Self-insured employers, including hospitals, will need to partner with national insurers to control the payroll contribution costs of insurance and work toward true cost reduction rather than simply shifting risk from employers over to consumers.
Emergency services will not be subject to additional costs because they were not provided by a participating network provider. Fees to the hospital and physicians will be the same if it is a true emergency. High health care costs keep people out of the hospital when they really need help and that goes against the purpose of providing the coverage in the first place.
Clinton wants to expand Obamacare and the incentives to states to expand Medicaid coverage. This includes adding a public option to choose between government-offered and privately-offered coverage, providing health care to all residents regardless of immigration status, and expanding the delivery system and technology for plans available through exchanges. Innovations in the delivery system can increase efficiency and maintain more accurate and accessible records. There will be rewards offered to insurers and providers contributing ideas for increased quality, consumer experience, and cost control.
Clinton will improve the value of Medicare and Medicaid coverage by standardizing the evaluation and improvement process. This means insurers need to work with large regional providers and America’s Health Insurance Plans (AHIP) which is part of the Core Quality Measures Collaborative (CQMC), along with many national physician organizations to remove poor quality hospital and physician services from networks and produce information to positively affect each facility’s business practices, cost, and patient satisfaction.
These five areas listed encompass many parts of the existing health care system and ACA law. Clinton’s election coverage will also show concerns for defending women’s rights for access to full health care, greater initiatives in autism research, Veteran’s health care, children’s vaccines, and the need for more research into the use of medical marijuana. Many of her enterprises go beyond the United States to become global health concerns as well. Overall, she wants greater culpability and better availability of health care and services and lower costs without disrupting Obamacare’s momentum. There is a continual need for improvement and she is focused on the parts of the law that need revising and expanding but with the same goal in mind: universal affordable health care coverage for all U.S, residents.
(The information provided in this article is from HealthcareMarketplace.com. The information on HealthcareMarketplace.com is independent and not associated with any state exchange or the federal marketplace. Additionally, the website is not associated with, sanctioned by or managed by the federal government, the Centers for Medicare & Medicaid, healthcare.gov or the Department of Health and Human services.)