Photo: KnowInsiders
Photo: KnowInsiders

What is ACA?

The Affordable Care Act (ACA) is the comprehensive healthcare reform signed into law by President Barack Obama in March 2010. Formally known as the Patient Protection and Affordable Care Act and often called Obamacare, the law includes a list of healthcare policies intended to expand access to health insurance to millions of uninsured Americans.

The act expanded Medicaid eligibility, created health insurance exchanges, mandated that Americans purchase or otherwise obtain health insurance, and prohibited insurance companies from denying coverage (or charging more) due to pre-existing conditions. It also allows children to remain on their parent's insurance plan until age 26.

It is that time of the year where Americans begin to think about their healthcare plans, but you will have to act quickly if you want your coverage to begin on January 1, as the cut-off date for this is tomorrow, December 15.

There have been almost 4.6 million Americans that have signed up to a healthcare plan through healthcare.gov or state-based insurance plans in the latest enrolment period, says data from the Centers for Medicaid and Medicare Services (CMS).

Enrolment initially began on November 1, 2021, and there is a lot of interest in the Affordable Care Act, otherwise known as Obamacare, as this is cheaper for the average consumer than what was previously available.

What are the Obamacare open enrollment deadlines for state-run exchanges?

The new rules clarify that states that run their own exchanges are still free to set their own enrollment deadline, as long as it’s not earlier than December 15. For 2022 coverage, New Mexico, Maine, and Kentucky have fully state-run exchanges, joining the 15 that already operated as of 2021. So there are 18 fully state-run exchanges that have the option to set an open enrollment deadline other than January 15.

The following deadlines have been announced by the state-run exchanges (note that some of these states are allowing extra time for people to get coverage effective January 1; the deadline for that in most states was December 15):

• Idaho (December 22; open enrollment has ended in Idaho)

• Colorado (January 15)

• Connecticut (January 15; enroll by December 31 for January 1 start date)

• Kentucky (January 15; enroll by December 31 for January 1 start date; extension is tornado/disaster-related)

• Maine (January 15)

• Maryland (January 15; enroll by December 31 for January 1 start date)

• Minnesota (January 15)

• Nevada (January 15; enroll by December 31 for January 1 start date)

• New Mexico (January 15; enroll by December 31 for January 1 start date)

• Pennsylvania (January 15)

• Washington (January 15)

• Vermont (January 15)

• Massachusetts (January 23; enroll by December 23 for January 1 start date)

• California (January 31; enroll by December 31 for January 1 start date)

• District of Columbia (January 31)

• Rhode Island (January 31; enroll by December 31 for January 1 start date)

• New Jersey (January 31; enroll by December 31 for January 1 start date)

• New York (January 31)

In the rest of the country, the open enrollment deadline is January 15. And enrollments completed between December 16 and January 15 will have coverage effective February 1.

How to Make Change

Those who already have marketplace coverage in 2021 can log in to their account to make changes to or renew their coverage for 2022. Even those who “may be automatically re-enrolled” should update any changes to their income or household as their “savings could be wrong” otherwise, according to HealthCare.gov.

They should also compare plans to make sure they don’t “miss out on new plans and prices that better meet your needs.”

How to Apply in 2022 Coverage Before the Deadline

Those who are new to the marketplace will need to create an account using their basic information.

Some states — including California, Idaho, Kentucky, Pennsylvania and Washington — run their own health care marketplaces. Those who live in those states can find information on where and how to apply on the HealthCare.gov website.

After creating an account, users can apply on the HealthCare.gov site, through a “certified enrollment partner’s website,” through the call center, through the mail or by contacting an “agent/broker or assister.” The HealthCare.gov site includes a checklist of the information people will need to have ready to apply.

Once their application is complete, applicants will be able to see if they qualify for a marketplace insurance plan with savings, such as “tax credits to help pay monthly premiums, or lower copayments, coinsurance, and deductibles.”

They can also see if they qualify for Medicaid and the Children’s Health Insurance Program and get an estimate. Applicants can then compare plans and prices in their area and pick the one that’s best for them. They will need to pay their premium to their insurance company for coverage to start

It is important to go to Healthcare.gov as soon as possible if you want your coverage to kick in once the New Year arrives, but even if you are okay waiting a little, the enrolment period will come to an end on January 15, 2022, so it is best not to wait too long.

The year 2022 sees 213 health insurance providers participate in the scheme, which is up 32 on the previous year. In addition to having more options to choice from, these plans will also be more affordable this year.

As a result of the enhanced subsidies from the 2021 American Rescue Plan Act, net premiums have decreased.

Earlier in 2021, more than two million people signed up for health insurance on Healthcare.gov during a Special Enrollment Period, which was established by a Biden Administration executive order.

What happens if You Miss the ACA Open Enrollment Period?

People who need to enroll in, re-enroll in or make changes to health coverage through the Affordable Care Act marketplace will need to meet the Dec. 15 deadline to ensure coverage starts on Jan. 1.

Those who miss that deadline and instead enroll by Jan. 15 won’t see their coverage start until Feb. 1, and those who don’t enroll by Jan. 15 won’t be able to get coverage in 2022 unless they qualify for a Special Enrollment Period.

If you missed the enrollment deadline, it is still possible to qualify for a Special Enrollment Period (SEP) that will allow you to apply for health insurance if you have experienced a qualifying life event. Qualifying life events can include:

*The loss of health insurance through a job.

*Household changes such as marriage, divorce, a death in the family, or having a baby.

*A move to a new home in a new zip, county or state.

*After open enrollment ends, people can normally only purchase coverage if they have a special enrollment period triggered by a qualifying event such as:

Marriage (since 2017, this generally only applies if at least one spouse already had coverage before the wedding, although there are some exceptions),

-Becoming a U.S. citizen,

-Birth or adoption,

-Involuntary loss of other health coverage.

-A permanent move to an area where new health plans are available (since July 2016, this only applies in most cases if you already had coverage prior to your move).

Where do you enroll in an ACA health insurance plan?

Photo: AARP
Photo: AARP

Affordable Care Act enrollment involves completing an application, choosing a plan, and paying your first premium, if needed.

The entry point for ACA enrollment is Healthcare.gov, the national marketplace website. At the top, click “Get Coverage” to select your state of residence. (People in U.S. territories can sign up only if they qualify as residents of one of the 50 states or the District of Columbia.)

Most states use the national marketplace system for applications. Some states run their own marketplaces. You will be directed to the appropriate site.

How do you prepare for the ACA enrollment process?

ACA health plan enrollment requires an application. You will need to have some information ready about you, the people in your household, and your income.

There are other ways to prepare for enrollment and determine your eligibility for ACA coverage. They include:

• An explainer: To learn more about the marketplace, you can read these quick tips.

• A savings estimator: Use this tool to determine if you might qualify for premium subsidies. You may learn that people in your household qualify for Medicaid or the Children’s Health Insurance Program (CHIP).

• Information about income: This tool can help you determine what counts as income.

If you are eligible for ACA coverage, the application will ask you about:

• Who you are: Basic information including your name and date of birth.

• Your household: Your spouse or partner, children in your home, and all dependents.

• Where you live: Your home and/or mailing addresses.

• Everyone applying for coverage: Social Security numbers or other information about everyone who you want to receive health insurance coverage.

• Your taxes: How you file — such as separately or jointly — and everyone you claim as a dependent.

• Your current income: Your employer and what you make from wages, tips, and other sources.

• Your 2022 estimated income: Your best guess about household income in 2022.

• Other insurance: Your current health coverage from jobs, Medicaid, and other insurers.

• Health reimbursement: If anyone in the household works for a business that offers help paying for health expenses through a health reimbursement account (HRA).

How do you contact an ACA navigator for help enrolling?

Photo: ACA Navigator
Photo: ACA Navigator

An ACA navigator is an individual or organization trained to walk you through the marketplace process. This includes eligibility and enrollment. These services are free. The Find Local Help tool will help you locate in-person assistance in your area.

Other tools and resources available to help you select the ACA plan that is right for you and your family include:

*Get help from someone in your community: Request help from a navigator who is an insurance agent or broker near you.

*ACA marketplace income levels & savings tool: Shows exact plan prices and what you might save on premiums.

*KFF health insurance marketplace calculator: The Kaiser Family Foundation helps you estimate your potential premiums and subsidies.

If you still have questions, contact the Marketplace Call Center at 800-318-2596. This line is available 24 hours a day, 7 days a week — excluding holidays.

What types of health insurance plans can you enroll in through the ACA?

The ACA will reach record affordability during the 2022 coverage year because of the American Rescue Plan Act of 2021. New financial assistance with premiums means that 4 out of 5 people will be able to find a plan for $10 or less per month.

After completing the application, you will select a plan.

Generally, ACA plans are organized into “metal tiers,” which determine how you and your plan will split the cost of care. The metal tier categories are:

• Bronze: Lowest monthly premium, but highest costs when you need care

• Silver: Known as the “benchmark” plan, with moderate monthly premiums and moderate costs when you need care; you must choose a silver plan to qualify for cost-sharing reductions. These are also known as “extra savings” on out-of-pocket expenses such as deductibles, copayments, and coinsurance.

• Gold: High monthly premium, but low costs when you need care

• Platinum: Highest monthly premium and the lowest costs when you need care

A Kaiser Family Foundation national analysis of marketplace plans for a 40-year-old person found that the average premium (without subsidies) for a silver plan in 2022 is $438. The price ranges from $309 in New Hampshire to $762 in Wyoming.

There are also catastrophic health plans for people under 30 and anyone with a hardship exemption. A hardship can include an affordability exemption for marketplace premiums or job-based insurance that are too expensive for you.

Catastrophic health plan premiums are very low. But, deductibles — which you pay out of pocket first before your benefits begin — are extremely high. All ACA catastrophic health plans had a deductible of $7,900 in 2019 and $8,150 in 2020. Hardships can include many circumstances, such as:

• You were homeless.

• You were evicted, faced eviction, or faced foreclosure.

• You experienced domestic violence.

• You experience a natural or human-made disaster, such as fire and flood, that caused substantial damage to your property.

• You received a shut-off notice from a utility company.

• You experienced the death of a family member.

• You filed for bankruptcy.

After your application is finished, you will need to pay your first premium (if any) to the insurance company for your coverage to begin.

Record number of Americans sign up for ACA health insurance

A record 13.6 million Americans have signed up for health coverage for 2022 on the Affordable Care Act marketplaces, with nearly a month remaining to enroll in most states, the Biden administration announced Wednesday.

President Joe Biden’s top health advisers credited the increased government subsidies, which lowered out-of-pocket costs, for the surge in enrollment. They also said enhanced personal assistance and outreach helped connect more people to health insurance plans.

Open enrollment for the marketplace began Nov. 1 and ends Jan. 15.

Through Dec. 15, enrollment in Florida had soared to 2.6 million people, up from 2.1 million in the same period a year earlier.

Enrollment has jumped more in states that have not expanded Medicaid because they have more uninsured residents than expansion states. In expansion states, people with incomes from 100% to 138% of the federal poverty level — about $12,880 and $17,770 for an individual — can enroll in Medicaid. In states that haven’t expanded the program, they can get subsidies to enroll in private plans through the Affordable Care Act marketplaces.

Georgia enrollment jumped to 653,990 from about 514,000 the previous year.

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