Several Changes In Store As Obamacare Open Enrollment Begins

Pearl Mccarthy
November 4, 2018

Last year, 85 percent of people in ME with marketplace plans qualified.

Those improvements will mostly be concentrated in urban areas of the state. If the Senate remains closely divided between parties, as appears likely, Congress can't repeal the Affordable Care Act (or "Obamacare") because it would take 60 votes to end debate and vote to undo all ACA regulations.

Also, the federal government has announced planned maintenance shutdowns of HealthCare.gov on most Sunday mornings during open enrollment.

A year ago, President Donald Trump unilaterally ended one of two major subsidies built into the law - payments to insurers to cushion them from discounts they must give lower-income customers on out-of-pocket costs.

Fred Ammons, chief executive of a nonprofit group that oversees Insure Georgia, the only navigator group available statewide since 2014, said his group did not get a grant this year, leaving only a smaller group that in the past focused on helping refugees around Atlanta.

"So on average they have baked in about six percentage points into their premiums with the expectation that healthy people might leave", she said. In the states relying on the federal marketplace, consumers sign up mainly through the HealthCare.gov website and federal call centers. The penalty is still in force for 2018, and when people pay their 2018 taxes they will pay a penalty for not having health insurance that is equal to the higher of these amounts: 2.5% of your annual household income or $695 per person ($347.50 per child under 18). But the law expanded Medicaid eligibility and included tax rebates for lower-income individuals to make coverage affordable. These short-term plans allow for coverage to fill temporary coverage gaps.

Critics charge that the law has led to costly and impersonal coverage, but supporters say it has led to sharp reductions in the number of uninsured in the nation.

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The sign-up period comes months after a U.S. Census report showed Texas still has the largest percentage of uninsured residents in the country at 17.3 percent, almost twice the national rate. This year, those incomes range from about $16,000 to $448,000 for an individual.

Short-term, limited duration options may offer lower premiums, but they won't cover as much.

Blue Cross Blue Shield of Arizona is the only insurer offering coverage in other counties. Residents of Maricopa and Pima counties will have more choices this year, with four insurance companies selling plans in Maricopa County and three in Pima County. WXXI's Brett Dahlberg has more on what that means.

"People need to be aware that those plans are not the same kinds of health insurance, that often times they don't cover preexisting conditions, that there may be some limits in there", she said.

Gjersvig said consumers can look for help and use resources available online or over the phone, which are offered in English and in Spanish. "It is confusing and there are some new products available that will further confuse people", he said. "It's also important to remember that companies may change the type of policy they sell from one year to the next". Reddy said the short-term plans, even though they are cheaper, may not always be a good choice.

CMS' Verma has argued that navigators are less needed now that Americans have had time to become familiar with ACA marketplaces. If you like your physician, make sure he/she is included in the plan network and check carrier directories for local hospitals to ensure easy access to "in-network" services, where possible.

"The mandate was weak in terms of penalties and enforcement, " he said.

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