People are anxious about what's going to happen with marketplace coverage next year. Even as Republicans contemplate their next move in the effort to undo the Affordable Care Act after the Senate GOP plan unraveled Monday night, the marketplaces are still likely offer plans this fall for 2018 coverage. Below I explain some of the important changes that are in the works that could affect consumers' enrollment and coverage next year.
Q: I stopped paying for my marketplace plan at the end of June because I couldn't afford the premiums. Will I have trouble this fall when I try to sign up for a new plan?
You could run into roadblocks. The Trump administration is giving insurers leeway next year to demand payment for unpaid premiums during the previous 12 months before allowing consumers to enroll (see page 18349) in one of the insurer's plans again.
The Affordable Care Act gives consumers who are receiving premium tax credits a "grace period" of three months to catch up if they fall behind on premiums. Under current regulations, if they don't make up the payments in three months, insurers can cut off consumers' coverage after the first month and aren't responsible for paying any claims that are pending after that.
But insurers complained that the rules encouraged consumers to game the system by halting their premium payments late in the year, hoping that they wouldn't need care. Then they'd re-enroll the following year, thus saving up to two month's worth of premiums without any penalty for the months that they didn't pay.
There are many reasons why people might drop coverage during the year, including the one you describe - that they're unable to afford it. According to a McKinsey & Company study, roughly 1 in 5 people who bought a marketplace plan in 2015 stopped paying it at some point during the year. Forty-nine percent of those people repurchased the same plan in 2016.
Insurers aren't required to adopt the administration's new approach and states can prohibit them from doing so if they wish.
The new rule for paying back premiums only applies if you want to buy a plan from the same insurer. If you switch insurers you can't be denied a new plan because you owe premiums to another company.
Insurers have to notify consumers of their policy in enrollment applications and nonpayment notices. But, even so, consumer advocates expect changes to cause confusion among consumers. Further, there's no mechanism in the new rule for consumers like you to contest a bill from an insurer for unpaid premiums that you don't believe you owe.
"Insurers are certainly going to try to collect everything they can," said Timothy Jost, an emeritus professor of law at Washington and Lee University who's an expert on the health law.
To avoid problems next year, make sure to call your insurer and cancel your current coverage before your 90-day grace period ends at the end of September, consumer advocates say.
Q: What happens if I sign up for a marketplace plan this fall and find out in January when I start using it that it's not a good plan for me? Can I switch?
Probably not. Unless you get married, have a baby or experience some other event that qualifies you for a special enrollment period, you'll have to stick with the same plan you chose during the open enrollment period, which will run for six weeks this fall from Nov. 1 - Dec. 15.
Last year, people had more wiggle room to switch plans in January and February, since the open enrollment period ran for three months, from Nov. 1 until Jan. 31.
Consumer advocates are concerned that consumers, many of whom wait to sign up for coverage until the end of the open enrollment period, might miss their window of opportunity this year.
In previous years when computer or other glitches slowed down the open enrollment process, the
Obama administration allowed people more time to sign up, said Sarah Lueck, senior policy analyst at the Center on Budget and Policy Priorities.
"The administration should be prepared to extend the open enrollment period" this year as well, Lueck said. But don't count on it.
Q: With all the uncertainty in the marketplaces, why not just buy a short-term plan that covers me up to $1 million? I know they're not as comprehensive as exchange plans but they're a lot cheaper.
The low premium may be tempting, but be careful what you wish for, say experts. If you have a pre-existing medical condition like high blood pressure or diabetes, insurers may simply decline to sell you a policy at all, or sell you one that doesn't cover any medical expenses related to that condition.
Once you have the plan, chances are you won't be able to renew it if you actually get sick, because unlike regular coverage short-term plans aren't guaranteed renewable.
Then there's the fine print. "A lot of the plans have hidden exclusions or caps on specific services that may come back and bite you," said Sabrina Corlette, research professor at Georgetown University's Center on Health Insurance Reforms. "When you read it through, it may say it will cover an appendectomy up to $2,500, or it will cover each day in the hospital up to $300."
Since short-term plans don't count as "minimum essential coverage" under the Affordable Care Act, you could owe a penalty for not having health insurance. For all the talk of repeal, that's still the law of the land.
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Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.