A nonprofit publication of the Kentucky Center for Public Service Journalism

Open enrollment for health care ends Dec. 15, but one-third of Americans remain unaware of deadline

By Melissa Patrick
Kentucky Health News

About a third of Americans haven’t heard anything about open enrollment for federally subsidized health insurance, and nearly half of them say they are hearing less about it this year than last year, according to a recent poll by the Kaiser Family Foundation.

That’s a problem, especially in Kentucky, where about 265,000 people had no health coverage in 2016. Of those, 114,000 were eligible for Medicaid and the other 151,000 could have bought a plan on Healthcare.gov — many with a subsidy to help pay for it, according to Kaiser.

Despite huge national cuts to programs that fund in-person helpers, Kentucky still has application assisters, formerly called Kynectors, in every county who can offer in-person help for free.

Here’s a short primer of what people need to know to sign up for insurance under the Patient Protection and Affordable Care Act:

What is open enrollment and when is the deadline to enroll?

Open enrollment is a set period of time when people can buy health insurance through the federal marketplace. Open enrollment on Healthcare.gov for 2018 ends Dec. 15. After Dec. 15, you can only sign up for a plan under special circumstances. Coverage for these plans takes effect on Jan. 1, 2018.

But don’t plan on shopping on Sunday mornings. Healthcare.gov is shut down for maintenance from midnight to noon Eastern Time on every Sunday, except for Dec. 10.

Am I required to have health insurance? The Affordable Care Act requires everyone to have health insurance or pay a penalty. And despite all the talk about whether this requirement, called the individual mandate, will remain the law, it still is.

What is the penalty to not have health insurance? The penalty in 2018 is $695 per adult and $347.50 per child, with a maximum of $2,085 per family or 2.5 percent of the household’s income.

The Kaiser Family Foundation has encouraged those who are uninsured to look into the cost of a plan because they could pay less in premiums than they would owe as an individual tax penalty for lacking coverage.

How do I enroll? Enrollment is through Healthcare.gov. This website will walk you through your options, including whether you will qualify for a subsidy or not. New users will have to create a user account and complete an online application. Current policyholders will have immediate access to the site’s shopping tool. Before you get started, make sure you have all of your tax records and personal information with you. There is also a place on Healthcare.gov to preview 2018 plans and get estimated prices before you log in. Click here.

But can’t I just automatically be re-enrolled?

If you are one of the 80,000 Kentuckians who already have a plan through the federal exchange, you will be automatically re-enrolled into the most similar plan available. But health experts say you make sure you are happy with your plan, because you won’t be able to change it in January, as in the past. They also advise that you compare plans and costs, since they have changed since last year.

What is a tax credit? 

People earning between 100 percent and 400 percent of the federal poverty line will qualify for federal tax credits to help them pay their monthly premiums on plans purchased through Healthcare.gov. The smaller your income, the larger your tax credit. Most people who qualify for a tax credit will find that the cost of insurance in 2018 will be about the same, according to the state’s health agency.

What is a cost-sharing reduction?

And didn’t President Trump end them? Cost sharing reductions are payments that reimbursed insurers for making plans more affordable for people who earn between 100 percent and 250 percent of the federal poverty level.

President Trump did stop these payments, but the two companies offering plans in Kentucky had prepared for this circumstance by increasing their premiums. And because the tax credit that helps pay premiums is based on the average cost of “silver” plans, those who qualify for assistance will get a larger subsidy.

In fact, some people’s subsidy will be large enough for them to qualify for a no-cost or low-cost bronze plan, but health experts warn that many of these bronze plans come with very high deductibles or large yearly out-of-pocket costs.

Still, not everyone will benefit from this change. For example, those who make too much money to qualify for a subsidy will likely have to pay more for their plans than in previous years.

What should I do if I make too much money to qualify for any help? 
Health advocates are encouraging the 20 percent of Kentuckians who don’t qualify for any help to look at plans off the exchange, as they could be less expensive.

em>Kentucky Department of Insurance map shows Anthem
counties in blue, CareSource in pink

Who is offering plans in my area? 

In Kentucky, Anthem Inc. is offering plans in 59 counties and CareSource is in the other 61.

Where can I get help? 

Assisters are avialable in every Kentucky county to help people sign up for coverage, and their services are free. There are also sign-up events throughout the state.

To find an event in your county or an assister, go to healthbenefitexchange.gov. The site also includes net payment examples for all regions of the state and 2018 sample scenarios for individuals and families.

Help is also available through the state call center at 858-459-6328 and the Healthcare.gov customer center at 800-318-2596, which is available 24 hours a day, seven days a week.

What’s the takeaway?

Advocates say: Sign up early, make sure you compare costs and plans and make an early appointment with your application assister. State officials remind Kentuckians to pay attention to their mail, text messages, phone calls and email about open enrollment, because that is how the state is spreading the word about open enrollment this year.

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