What's New in 2018
With the recent change in administration, there have been new policies for the marketplace in 2018 and beyond. Below is a summary of the changes with links to updated or new Frequent Asked Questions (FAQs).
- Shorter open enrollment period: the open enrollment period for federally facilitated marketplaces (FFM) begins November 1, 2017 and ends December 15, 2017. This means new and returning consumers must apply for marketplace coverage by Friday, December 15, 2017 for coverage to start January 1, 2018. After December 15th, consumers can only enroll if they qualify for a special enrollment period. State-based marketplaces may have longer open enrollment periods so please check with your marketplace. See this FAQ on open enrollment.
- Past due premiums: if you have any past premiums due to the insurer for coverage within the prior 12 months, your insurer may require that you pay these past-due premiums before enrolling you into coverage. This applies to both open enrollment and special enrollment periods. See this FAQ on how past due premiums for previous 12-month coverage can affect your ability to enroll into new coverage with the same insurer.
- Comparing plans: insurers now have greater flexibility in meeting the minimum levels of coverage (called actuarial values) for the Bronze, Silver, Gold and Platinum plan metal levels, which may affect how much consumers will pay out-of-pocket when using their health care coverage. See this FAQ on plan metal levels and this FAQ on silver plans versus bronze plans.
- Discontinuation of premium tax credit and cost-sharing reductions: in addition to last year’s procedure in which the marketplace discontinued premium tax credits and cost-sharing reductions to those consumers who received premium tax credits, but did not file a tax return for that year, this year the marketplace will also discontinue premium tax credits and cost-sharing reductions to consumers who filed a tax return but did not reconcile advanced premium tax credits using IRS Form 8962. See this FAQ.
- Direct enrollment with agents, brokers, and insurers: unlike previous years in which agent, broker, and insurer websites directed consumers to the marketplace to apply for financial assistance, consumers may apply for financial assistance directly using agent, broker, and insurer websites, although they will still need a HealthCare.gov account in the FFM. See this FAQ for more on direct enrollment.
- Small Business Health Options Program (SHOP): the federally facilitated SHOP marketplace will no longer enroll employers or employees into SHOP coverage, but rather direct them to SHOP-registered agents or brokers. The SHOP marketplace will continue to make determinations on SHOP coverage eligibility for small employers and eligibility for the small business health care tax credit. See this FAQ on SHOP and this FAQ on the small business health care tax credit.
- Special enrollment periods (SEPs): There are a number of changes that apply to SEPs, summarized in the background section under Open and Special Enrollment Periods. The biggest change with SEPs is the requirement to verify common qualifying events like moving, getting married, or losing qualifying coverage with documentation before being able to enroll. Other changes include limiting plan choices under a SEP, see this FAQ, and requiring at least one spouse to have had continuous coverage in order to qualify for a SEP through marriage, see this FAQ.
There may be some confusion about the requirement to have health insurance coverage or the individual mandate, which is still law and in effect. Individuals are still required to have health insurance. See this FAQ on the requirement to have health insurance. Another area of confusion may be about subsidies to reduce cost-sharing or out-of-pocket costs; these subsidies are still available for eligible consumers, see this FAQ. And there also may be fewer plans this year in some areas and concerns that some insurers may discontinue or pull out of the marketplace altogether, see this FAQ.