Updated Sept. 8, 2018: Health care in the U.S. has long been contentious, to say the least. But while almost every facet of our current system, old system and theoretical system is debateable ad nauseum, we can (probably) all agree on one thing: Health insurance is confusing.
Today’s political climate — which saw Republicans try to overturn the President Barack Obama's health care law seven times before ultimately repealing its tax penalty last year — certainly hasn’t made things clearer. In fact, at this point, there’s no need to feel embarrassed if you’re unsure whether Obamacare, formally known as The Affordable Care Act, is still a thing. (It is. Mostly.) So, to help you get ready for open enrollment 2019, here are the answers to 20 questions about Obamacare you’re too embarrassed to ask.
1. Is Obamacare happening this year?
Yes. Federal open enrollment begins Nov. 1, 2018 and ends on Dec. 15, 2018. Some state-run exchanges are open for a wider window. You can go here to find the complete list of Obamacare open enrollment deadlines by state.
2. Umm ... what’s open enrollment?
Obamacare follows the workplace model where you can only sign up for a health care plan during a set time of year. Open enrollment is that time.
3. And it's only once a year?
Yes, but, also like employer-sponsored health insurance, there are special enrollment periods for anyone who has what’s considered a qualifying event. When it comes to Obamacare, those events include a loss of health insurance, a change of zip code and big life stuff, like getting married (or divorced), having a baby or adopting a child. You can also apply and enroll in Medicaid or the Children's Health Insurance Program (CHIP) any time of year.
4. What is Medicaid — and how can I find out if I qualify?
Medicaid is the federal-and-state-funded health insurance program for low-income, needy Americans and their families. Check out our state-by-state guide to Medicaid requirements to see if you're eligible for the program.
5. I don’t have health insurance. Do I have to buy Obamacare coverage?
Technically, no. But you probably should. Yes, Obamacare's federal mandate — a tax penalty for forgoing health insurance — got formally repealed as part of broader tax reform signed into law by President Donald Trump last year. But some states has instituted their own version of the mandate and, morever, if you don't buy health insurance, you won't have health insurance — medicals aren't cheap.
6. Are the Obamacare exchanges the only places I can get coverage?
No. You can get a health care plan from, well, anywhere you can get a health care plan (including through an employer, just to be clear). The exchanges are designed to help people who don’t have access to affordable health care through work. But there are plans sold off-exchange, too.
7. Are off-exchange plans cheaper?
That's a complicated question. For starters, Obamacare left a lot of decisions to the states — like whether to expand Medicaid — and, beyond that, some counties are simply smaller and/or sicker than others. So, without getting too in the weeds here, the price of health insurance varies dramatically across state lines or even zip codes. Plus, what you’ll ultimately pay for healthcare hinges on whether you’re eligible for subsidies or free coverage.
8. Wait, what are subsidies?
Yeah, that’s something that gets lost when people talk about soaring Obamacare premiums. The price of healthcare on the exchanges has gone up in recent years and, taken at face value, often look sky-high. But the percentages you see touted in most reports don’t account for the financial assistance exchange shoppers are eligible for. Under Obamacare, people who earn between 100% and 400% of the federal poverty level and purchase a plan through the exchange qualify for premium subsidies that offset their monthly insurance payments. These subsidies are actually a tax credit you can receive in advance. Obamacre also allows for what’s known as cost-sharing reductions (CSRs) designed to help people who make between 100% and 250% of the poverty line cover copays and deductibles.
9. Yeah, but how likely am I to qualify for any of that? Didn't Trump nix subsidies?
He decided to stop making CSR payments to insurers, meaning they're no longer getting reimbursed for the copay and deductible discounts they're giving consumers.
10. How can he do that? I thought you said Obamacare didn't get repealed?
It didn't, outside of the individual mandate, of course. But the original law mandates the federal government provide premium subsidies, but not make CSR payments. President Barack Obama was doing so under executive order. The Republican-controlled House of Representatives sued his administration over the move and won, but that ruling was in limbo while the case was being appealed. Back in October 2017, Trump effectively pulled the appeal and nixed the payments — which immediately led many insurers to up premiums right before the 2018 exchanges opened.
11. Sheesh. So, like ... why even bother buying health insurance this year? Isn’t Obamacare supposed to get repealed by the Trump administration anyway?
Well, first, there's no guarantee Obamacare will get fully repealed and replaced (or just repealed). And, second, subsidies are still are the table. In fact, thanks to some savvy strategizing from state regulators and insurance companies, many Americans wound up getting more monetary help last year. Seriously. We talked to people shopping the 2018 exchanges who were paying premiums well below what they were paying in 2017.
12. How did that happen?
It's a long story, but basically because many states front-loaded the resulting premium increases onto their Silver plans and the price of a Silver plan dictates how much of a premium tax credit (still a thing) people qualify for. Basically, the higher the price of the Silver plan, the higher the premium subsidy, the less eligible shoppers actually pay for health insurance.
13. Is that happening again this year?
Yes, early review of proposed rates from insurers — which won't be finalized until October — show moderate increases to small decreases, on average, when it comes to premiums this year. The stabilization of prices is largely related to how companies and state commissioners are leveraging Silver plans.
14. What if I live in a state that has a weak exchange or don't qualify for subsidies ?
We hear you, but bottomline, don’t forgo buying health insurance on the assumption it’s simply too expensive. There are options out there. We can help you easily compare on-exchange and off-exchange health insurance plans once open enrollment kicks off. And, if you can't find an affordable health plan, there are a few alternatives to pursue.
15. Like those short-term health insurance plans or health association plans I keep hearing about?
Yes, Trump widened access to those plans through executive order early this year. Keep in mind, short-term health plans and health association plans don't have to provide as much coverage as the plans sold on HealthCare.gov, so while their premiums are cheaper, don't think of them as a plan of first resort. Log onto your state exchange to see if you qualify for subsidies, more robust coverage or affordable premiums before blindly tapping those alternatives. Need help shopping? Learn how to spot a health junk insurance plan.
16. Is it worth looking into off-exchange plans ahead of time, too?
It’s not — in large part due to the Obamacare, which requires all health plans cover what’s known as the 10 essential benefits. On-exchange plans have to meet even more requirements (like building in pediatrics benefits, for one), so some insurers opt to offer a plan off-exchange because it’ll give them more freedom when structuring a policy. You can learn the differences between on- and off-exchange plans here, but the big thing to note is off-exchange plans don’t qualify for any federal subsidies.
17. Can I shop the Obamacare exchanges if I have access to employer-sponsored healthcare?
Yes, and, if the health insurance your job offers is crappy — let’s say you have a super-high deductible or very, very high premiums— it’s worth checking out the exchanges to see if you can get a better plan. Keep in mind, though, employees with access to employer-sponsored healthcare won’t qualify for subsidies if it’s what the government considers “affordable”. In 2017, that meant a job-based health plan covering only the employee that costs 9.69% or less of the employee’s household income and met minimums standards of coverage.
18. What’s a deductible?
The amount of money you have to pay out of pocket before your health insurance kicks in. The other important aspects of healthcare include your co-pay (the fixed amount you’ll pay for prescriptions and services), your premium (essentially your monthly health insurance bill) and coinsurance (which is similar to a copay, but goes by percentages. So if you have a 20% coinsurance, you’ll pay 20% of the cost of covered services until you reach your out-of-pocket maximum). For more Healthcare 101, go here.
19. How do I sign up for an Obamacare plan?
So glad you asked! We’ve got a step-by-step guide to shopping the ACA exchanges that’ll walk you through it.
20. I have an Obamacare plan already. Do I need to re-enroll?
So, if you don’t hop onto Healthcare.gov to renew, change or cancel your coverage or your plan is no longer available in 2018, you might get automatically rolled over into the same plan or a comparable one. You should get two letters (one from your insurer and one from the marketplace) before Nov. 1 2018 that explain your coverage status, outline any changes and let you know if you need to forward any paperwork to the exchange. No matter what the case, though, it’s worth logging on to Healthcare.gov during open enrollment to ensure you’re all set for next year … and to see if there are any better plans available to you.
Image: Cecilie Arcurs