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ACA? OE? OMG. What’s up with health insurance?

Even under ordinary circumstances, health insurance is a seriously complex topic. This year, navigating the health care landscape is more challenging than usual.

So we’ll start by skipping the maze and going straight to what we know. The Affordable Care Act (ACA) is still in effect.

The ACA was enacted in 2010 to make health insurance available to every American. It established new rules for the “individual marketplace” (what it's called when people shop for insurance for themselves instead of getting it through employers, Medicare or Medicaid) which include:

  • Carriers can’t turn anyone down for pre-existing conditions or impose lifetime caps on coverage

  • Individuals must carry basic coverage (emergency care, maternity care, hospitalization, Rx drugs etc.) or pay a penalty

The ACA, sometimes called Obamacare, also created “Health Exchanges” where people can buy plans from insurance carriers – including plans subsidized by the government for households that qualify. Also, the ACA began making tax credits available to qualifying households to lower the cost of insurance. (Plug: if you shop through Mylo, you can calculate whether you’re eligible for one.)

The ACA also placed a mandate on employers to provide basic coverage if they have 50 or more Full Time (or Full Time Equivalent) employees.

Finally, the ACA established a specific time period called Open Enrollment (OE) when any individuals can enroll in health insurance. That’s still in effect too. This year’s dates are Nov. 1 – Dec. 15, 2017. That’s half as long as in previous years, but certain states have already extended the deadline:

  • California – January 31
  • Colorado – January 12
  • Connecticut – December 22
  • District of Columbia – January 31
  • Massachusetts – January 23
  • Minnesota – January 14
  • New York – January 31
  • Rhode Island – January 1
  • Washington – January 15

Outside of this window, you can only enroll in health insurance if you’ve had a Qualifying Life Event (such as losing coverage, getting married or divorced, having a baby, etc.) More details here.

Fans of the ACA say that it cut the uninsured rate in half, slowed the growth of medical spending, and lifted a burden from people with long-term health conditions. Detractors say it caused premiums to skyrocket because not enough healthy people participated, drove carriers to leave key markets, and imposed unconstitutional burdens on carriers and individuals.

Opponents of the Affordable Care Act took control of the presidency, Senate and House in 2017. Since then, there have been several attempts to overturn the ACA – but no complete success yet.

(If you want to geek out on the details, read "ACA Repeal and Replace: A Timeline". Or keep reading to go straight to where it stands now.)

UPDATE (FASTEN YOUR SEATBELT):

In October, the Trump administration took two actions that don’t actually repeal or replace the ACA but are intended to weaken it:

1) President Trump announced that the government will stop paying insurance carriers the federal subsidies intended to make Health Exchange plans affordable for qualifying households. This move could cause more insurance carriers to leave the Health Exchanges.

These payments will stop as early as this month – affecting the remainder of 2017 plans as well as new 2018 plans – unless Congress passes a workaround bill. More details here.

2) President Trump signed an executive order intended to bring down premiums by recommending that key federal agencies consider:

  • Letting individuals purchase Short Term Medical Plans for longer than the current limit of 6 months to a year. These plans are more affordable than comprehensive health insurance, but do not provide ACA-mandated basic coverage. Insurers can also drop people or exclude them for pre-existing conditions.

  • Letting individuals and small businesses band together into associations and buy the types of group plans available to large businesses (which allow for lower rates based on the health of the company’s population) and also go across state lines to buy plans that avoid a specific state’s regulations.

  • Letting larger businesses offer Health Reimbursement Arrangement (HRA) accounts to employees instead of providing group health insurance. (Currently, only companies with fewer than 50 employees can do this.)

This executive order most likely won’t affect this year’s Open Enrollment. More details here.

3) President Trump issued rules that exempt employers from providing coverage for contraception (one of the ACA’s essential benefits) if they have closely-held moral objections.

This change is in effect during this year’s Open Enrollment. More details here.

SO WHAT’S NEXT?

Breaking news: there are strong feelings on both sides of the ACA debate.

It probably won’t be ending any time soon – and the uncertainty is being felt throughout the insurance industry. Some top carriers have left the state health exchanges … and more could do so in the future.

Other current developments to watch: two different bills (one Republican and one bipartisan) have been proposed (but not yet brought before Congress) for funding the subsidies paid to insurance carriers to make health insurance more affordable for qualifying households.

The Mylo team (along with our parent company Lockton) is keeping a close watch on things and will update you on any changes. For now, some key points to keep in mind:

  • The Affordable Care Act is still in effect
  • Open Enrollment is Nov. 1 – Dec. 15, 2017 (right now!)
  • If you need to enroll in a new health plan or shop for something better than you have now, it’s good to start getting prepped now. This guide can help.

Need additional help navigating the maze of health insurance options? Call the friendly licensed agents at Mylo for the most up-to-date plans! We look forward to helping you out, even if you just want advice.

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