This month’s newsletter addresses the national marketplace open enrollment for individual policies.
While it’s business as usual for employers, it’s important to understand the market instability that exists in the individual insurance market due to Congress’ lack of commitment to fund cost-sharing subsidies. These subsidies (payments) to insurers are currently subject to legal challenges, and the administration has been unclear on whether it intends to continue to fund them (or ask Congress to do so legislatively).
Distinct from the subsidies that help individuals pay their premiums, the ACA’s cost-sharing reduction subsidies help individuals with incomes between 100 and 250 percent of the Federal Poverty Level pay deductibles and co-payments. Nearly three in five individuals covered on the Exchanges are eligible for these subsidies.
Although the Marketplace Open Enrollment will impact each employer differently, here’s what you need to know.
1. The Open Enrollment deadlines have changed In an effort to improve the risk pool and promote stability in the individual insurance market for 2018, the length of the 2018 open enrollment period will be reduced from three months to just 45 days.
2. You must sign up during open enrollment if you don’t have health insurance from another source
3. If you miss Open Enrollment, you may have to wait a year until you can sign up, unless you qualify for a special enrollment Here’s what might trigger a special enrollment: divorce, marriage, birth or adoption of a child, death of a spouse or partner that leaves you without health insurance, your spouse or partner who has you covered loses his/her job and health insurance, you lose your job and with it your health insurance, your hours are cut making you ineligible for your employer’s health insurance plan, or you are in an HMO and move outside its coverage area.
4. Under the Affordable Care Act (ACA), you are required to have health coverage or you may be subject to a penalty If you went without health insurance in 2017, the penalty is 2.5 percent of your income or $695 per adult (whichever is more) and the penalty for each child in the family without coverage will be up to $347.50. The maximum penalty is set at $2,085. For the 2018 tax year and beyond, the penalty will remain at 2.5 percent, but the flat and maximum amounts will adjust for inflation.
If you owe a penalty, it will be taken from your tax refund.