The Affordable Care Act Today

The Affordable Care Act Today

How has health insurance changed under the Trump administration?

You may be wondering what has changed over the last two years with the health care laws. With a new administration in power, and much talk of the law changing going forward, there is still some confusion on what the current state of health insurance and the law is.

We have received calls asking if the health care reform law, called the Affordable Care Act, is still in effect, even under President Trump. It is good to understand what all has changed and what has stayed the same, and what this means for you.

What changed?

Individual Mandate

The biggest change that consumers may notice is that the individual mandate which requires most people to have a qualified health insurance plan or face a tax penalty, will be zeroed out for 2019. That means there will be no penalty for 2019 and the foreseeable future. The coverage year of 2018 will be the last year you will have a tax fee to pay for not having qualified coverage.

Short Term plans

There is now expanded access to cheaper, less comprehensive insurance, often called Short Term plans. Healthy people who can pass the health underwriting requirements now have the option to move away from qualified plans and purchase these lesser-coverage plans for more than just three months at a time. Starting in 2019, those that choose this option will no longer have to pay a tax penalty for not having a qualified health plan.

Open Enrollment

The final change that affects the average consumer is that the Open Enrollment period was cut in half, from a twelve-week period, to 6 weeks. This began last year for the 2018 Open Enrollment, and is the same for 2019 Open Enrollment, lasting from November 1 to December 15th. This means you will only have 6 weeks to decide on your coverage for 2019 and submit your enrollment for a qualified plan, if that is the type of coverage you choose.

Though there have been some changes, most of the Affordable Care Act remains in place and unchanged.

What is the same?

Pre-existing conditions are allowed

There are still no pre-existing condition requirements, meaning that anyone can qualify to obtain coverage through an on or off exchange qualified plan, regardless of their health status.

On Exchange plans and Healthcare.gov

The Health Insurance Marketplace through healthcare.gov still exists, providing on-exchange plans. They work with the insurance companies to provide plans at the same price as off the Marketplace. You may qualify to receive help paying your premiums for these plans, based on your family size and household income, among other factors. The only way to receive this help, called a tax-credit subsidy is to purchase your coverage through healthcare.gov. You will be required to submit proof of income, and possibly other proof that shows you qualify to receive a subsidy, so pay attention to what documentation healthcare.gov says they will need from you.

Healthcare.gov can also help you determine whether you qualify for Medicaid or CHIP (PeachCare in Georgia).

Having an agent can greatly assist with information about on-exchange plans and with navigating the enrollment process with healthcare.gov.

Off Exchange Plans

Of course, off-exchange plans are also available in most parts of the country, and an agent can help you go directly to the insurance carrier to purchase your coverage, without having to go through healthcare.gov for insurance.

Which insurance companies and plans are available in different areas typically changes yearly. You may be able to keep your plan from the previous year, or you may need to go through the process each year to select a new plan, based on needs, new options, prices, and what may no longer be available.

Qualifying Life Events and Special Enrollment Periods

You cannot enroll in a qualified plan (whether on or off exchange) outside of the annual Open Enrollment period, unless you have a qualifying life event. If you have a qualifying life event, you must provide proof showing you lost coverage and the date it was lost. You are then given a Special Enrollment Period, allowing you to enroll in a plan.

Qualifying Life Events include birth or adoption or something that causes you to lose other qualified coverage like marriage, divorce or legal separation, loss of employer-sponsored health insurance due to termination of employment or loss of eligibility for coverage, loss of coverage for dependents turning 26, exhaustion of COBRA, loss of eligibility for Medicaid or CHIP, among others.

10 Essential Health Benefits

The law requires that all qualified health plans include the following benefits: ambulatory outpatient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorder services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services.

What does this mean for me?

Beginning with the 2019 coverage year, clients can look at health coverage options that include non-qualified plans and not worry about paying a tax penalty.

This means you have options!

Some of your options for 2019 include:

  • Off-exchange plans
  • On exchange plans
  • Small group plans
  • Short Term plans
  • Christian sharing plans
  • Flat-fee membership for physician care paired with other insurance products

We strongly recommend having a trusted agent help you decide which choice is right for you for 2019.

Terri is booking consultation appointments NOW, and Open Enrollment begins November 1st!

Menu