Chris HopkinsThe open enrollment period for insurance under the Affordable Care Act began last Saturday.. The signup deadline is Dec. 15 for coverage beginning Jan. 1. Individuals who are not covered at work or not otherwise exempted must enroll by Feb. 15 to avoid paying a penalty.
For the 7.1 million current subscribers, it is important to review your options for the New Year even if you wish to keep the same coverage. Since the patently maladroit rollout of the initial offering, new plans and new providers have joined the platform. It may be possible to find an offering that better suits your needs or costs less. On the other hand, some plans are being dropped from the exchanges, and if yours is one of those you will need to select a replacement. In most cases the insurer will select an alternative for you if you do not respond, but you may find yourself with higher premiums or greater out of pocket costs.
It is also essential to update any pertinent financial information when you re-up this year. Roughly 85 percent of enrollees qualify for subsidies based upon family income. Changes in wages or employment status could impact your subsidy payments for next year, and may even result in your having to pay up at tax time if your income increases.
Furthermore, alterations to plans and rate changes for so-called "baseline" plans could affect the basic amount of subsidy payments and might impact the assistance you receive.
If you are presently uninsured and do not have access to your employer's coverage, you will likely need to log on and complete the application process. Penalties for failing to obtain coverage are increasing substantially this year to $325 per adult or 2 percent of income, whichever is greatest.
The Obama administration expects an additional 2 million to 3 million new subscribers this year, assisted by a functional website and more and better choices. In Hamilton County, Tennessee for example, there are 87 different plans offered with a wide range of deductibles and costs. Plans are classified by share of coverage: bronze, silver, gold and platinum. Bronze plans cover about 60 percent of health care expenses, while platinum packages take care of 90 percent. Monthly premiums vary accordingly.
A bare-bones "catastrophic plan" is available to young adults or those with a hardship exemption.
Certain preventive services are covered 100 percent regardless of which precious metal you select. For instance, colonoscopies, mammograms, immunizations and screening for diabetes, depression, HIV and high blood pressure are all covered with no deductible or copayment under all the plans.
Getting sufficient information to the 36 million uninsured remains a significant challenge as two recent Kaiser Family Foundation studies illustrate. Among uninsured adults, nearly nine out of 10 were unaware that the new ACA enrollment period was approaching. Meanwhile, merely understanding enough terminology to successfully navigate the choices presents an obstacle. Over 40 percent were unfamiliar with basic concepts such as deductibles and premiums.
The Affordable Care Act contains significant defects and is financially unsustainable in its current incarnation. Nonetheless it is here to stay and will continue to be remodeled in the years ahead. The much-improved Healthcare.gov site now offers a chance to shop and compare before completing the application. It also includes a "find local help" link on the home page to search for approved counselors in your area that can assist you in navigating the choices.
It is important for both current subscribers and for people without coverage to log on and find the best fit before the end of open enrollment.
Christopher A. Hopkins, CFA, is vice president and portfoilio manager at Barnett & Co.