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Procrastinator’s guide to getting covered in 2018

It’s been a bumpy road for the Affordable Care Act in 2017, but the law is still standing: Republicans’ efforts to “repeal and replace” it fell apart over the summer, and the recent election of Senator Doug Jones in Alabama, means that they’re unlikely to try again in 2018.

With repeal off the table, the Trump administration instead seems set on doing everything in it’s power to make the law work less well. Perhaps as part of that effort they drastically shortened the open enrollment period where anyone can sign up for Obamacare. Last year, you had until January 31 to sign up for a 2017 plan; this year, TODAY (Dec. 15) is the last day to buy a plan for 2018 in most states.

However, as long as you’re “in line” (that is, in the process of trying to buy a plan) by midnight tonight you can still get coverage. Also, a number of states have extended their deadlines, so even if you’re reading this after December 15, it’s still worth logging onto healthcare.gov to check. Plus if your income is low enough you and your family might qualify for Medicaid, and you can enroll in that an any time.

And for those of you in a rush to pick a plan before the deadline, here’s a bunch of helpful information to help you make it through quickly!

Important stuff to know for 2018 enrollment

Deadlines: Open enrollment only lasted for a month and a half this year– from November 1 to December 15. However, a few things to keep in mind:

  1. Like we said earlier, a bunch of states have chosen to extend the deadline, so even if you’re reading this after December 15, you still might be able to buy coverage;
  2. That the deadline only applies to private coverage– if your income is low enough to qualify for Medicaid you can enroll in that at any time; and
  3. If you have a life change during the year– lose a job, have a child, etc.– you can get private insurance coverage through the marketplace then too.

Income guidelines: The cutoffs for Medicaid and subsidies to help pay for premiums are both based on the federal poverty level (FPL), which is a little higher this year than it was last year. (For example, last year the FPL for a single adult was $11,880– for 2018 coverage it’s $12,060.)  You can see the new guidelines in this chart:

The penalty for not having coverage: For the first couple of years after Obamacare took effect, the individual mandate was phased in slowly, giving people a chance to get used to the new system. This year though, like the past couple years, the individual mandate is in full effect. The penalty for going without coverage in 2017 is $695 per adult (and $347.50 per child), up to a maximum of $2,085 per household; or 2% of your household’s income– whichever is greater. You’d pay that amount on your 2018 taxes.

Also, yes, Republicans in Congress have been talking about repealing the individual mandate as part of their tax reform plan. However, even if they do manage to pass a bill that eliminates the mandate, it wouldn’t take effect until 2019, which means that if you’re not covered this year, you’ll still owe.

Why you should NOT just auto-renew your Obamacare plan: If you already have coverage through the Obamacare exchanges and don’t do anything, you’ll automatically be enrolled in your current plan. As we’ve explained in the past, auto-renewing has always been a bad idea. For starters, the details of your plan might have changed– and as this tool from ProPublica illustrates (it’s from 2015, but the principle will be the same this year), sometimes the difference can be dramatic:

insurance plan changes example

But also, just as importantly, even if your plan doesn’t change, what you pay may be totally different. Most people are getting a federal subsidy to help pay for coverage, which is calculated based on three things: (1) the sticker price of your plan, (2) your income, and (3) the price of a “benchmark” silver plan. Even if your plan’s sticker price and your income will be exactly the same in 2017 (and chances are they won’t), if the price of that benchmark plan changed, then what you pay for your premium could be very different this year.

However, this year, because the Trump administration decided to stop paying the ACA’s cost-sharing reduction (CSR) subsidies, the cost of many plans will be wildly different this year. Under the ACA, people making less than 250% of the federal poverty line are eligible for CSR subsidies that help make their deductibles and other out-of-pocket costs much more affordable.

Even though Trump decided to stop paying the CSR’s, under the law insurers are still obligated to provide them to consumers who qualify, which means they’ve had to increase the cost of premiums for Silver plans dramatically. The subsidies that make your premiums more affordable are tied to the cost of Silver plans, so the change means your subsidy could be pretty different as well. Different states have reacted differently to the changes, so you definitely want to log back onto your state’s marketplace to see what’s different and if it makes sense to find another plan.

By the way, if you don’t log back onto the Obamacare marketplace to ask for a redetermination of your subsidy, it will automatically apply the subsidy you got last year– even though it’s probably wrong– and if it’s too large, you’ll have to pay some of it back when you file your 2018 taxes. Also, you may find that another plan is much cheaper this year– so it pays to shop around.

The basics

Explainer: How you’ll get coverage under Obamacare: If you’re totally new to all this Obamacare stuff, this is the place to start. There we explain in more detail:

  • Who gets coverage through the Obamacare marketplaces? Anyone who’s not already covered through an employer, Medicaid, Medicare, the military, etc.
  • Where do you get coverage? Healthcare.gov
  • When do you get coverage? This year’s open enrollment lasts until January 31. You can apply to Medicaid at any time during the year, but your income has to be below 138% of the FPL (or perhaps lower than that even if your state didn’t expand) to qualify. If your income is above that cutoff, you can only buy coverage after Dec. 15th if you have a qualifying life event (like having a baby, losing coverage through an employer, etc.).
  • What kind of coverage is available? Medicaid for those with incomes below the FPL and private coverage for everyone else. Private coverage is broken into different tiers: bronze, silver, gold, platinum, and catastrophic. The tiers are based on actuarial value, which is super complicated– all you really need to know is that bronze plans will have lower premiums and higher out-of-pocket costs, while gold and platinum plans will have higher premiums but lower out-of-pocket costs. Silver plans are mid-range… usually. (See below about “The OTHER Obamacare subsidy hardly anyone knows about.”)
    How much you’ll pay/how the subsidies work: Subsidies are on a sliding scale based on income, and anyone making below 400% of the FPL may be eligible.

Five terms you need to know before you buy Obamacare coverage: Buying insurance can be ridiculously complicated, especially if you’ve never done it before. Here we explain the terms you need to know to understand the coverage you’re choosing– premiums, deductible, co-pay, coinsurance, and out-of-pocket maximum– and how they work together. (Even if you think you know these concepts, you might want to brush up. One study from a healthcare economist at Carnegie Mellon University found that just 14% of respondents with insurance could correctly identify all of those terms.)

The plans and subsidies

What the “actuarial value” of a plan is (and why you should ignore it): Some people see a 60% actuarial value, and think that means the plan will only cover 60% of serious medical expenses, leaving them on the hook for 40% of a potentially huge bill. Fortunately that’s not how actuarial value works– it’s simply an average across the entire population covered by the plan. Only insurance company actuaries need to worry about the specific percentage; for everyone else, just know that lower actuarial value will mean higher out-of-pocket costs.

How your Obamacare subsidy is calculated: an advanced lesson: When you apply through the online marketplace it automatically calculates your subsidy. For most people that’s fine, but if you have more complicated questions about why your subsidy is what it is (for example, if you’re a young person wondering why you don’t qualify for a subsidy even though your income is below 400% of the FPL) and don’t mind a little math, this post will explain.

The OTHER Obamacare subsidy hardly anyone knows about: Most people have probably heard that there are subsidies to help pay for premiums based on income. What you might not know is that if you make less than 250% of the FPL (see the FPL chart above) you also qualify for reduced out-of-pocket costs– but only if you buy a silver-level plan. This is the CSR thing we mentioned above, and like we said insurers still have to offer these reductions, even though the Trump administration pulled their funding.

Special Cases

An Obamacare guide for freelancers and the self-employed: To get the subsidy to pay for insurance, you have to estimate what your income will be in 2018. If you work a job with a salary or steady hours estimating your income is pretty straight-forward, but if you’re a freelancer or self-employed chances are you have no idea what your income will be next year. This post has some advice for you.

Five things non-citizens need to know about Obamacare: This is the group that will have the hardest time applying for health coverage. Eligibility for subsidies or Medicaid also depends on income for this group, but on top of that immigration status, how long you’ve lived in the country, and in some cases country of origin will all play a role. Here are the most important things you need to know to get covered.

And finally…

Kaiser Family Foundation has a pretty great FAQ page if you have any questions that aren’t answered in the posts above and a a few important tips to keep in mind if you’re thinking about signing up. Families USA has a fantastic guide for what to do after you sign up to make sure you get the most out of your new coverage. They also have tons of other easy-to-understand guides on how to apply for health coverage, get financial assistance, choosing a health plan, and more. And finally, we’re always up for answering your Obamacare questions on our Facebook page– leave your questions there or in the comments below and we’ll do our best to answer ASAP!

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