The Risks And Benefits With The Health Insurance Marketplace

Health Insurance Marketplace

Healthcare is an expensive business in the US, for both the facilities and the patients. Many people struggle to pay their costs or find access to affordable health insurance policies. Then there is the added pressure of fees and penalties for those that are not covered. Some households may face a penalty of 2.5% of the gross household income (MAGI).

The world of health care insurance and Obamacare is a minefield for all those still looking for coverage. Ongoing concerns over the future of the ACA don’t help the situation. With the 2018 enrollment period (Nov 1 until Dec 15) looming, there is a lot for the average citizen to consider.

The prospect of applying for health insurance is daunting to all those new to the system. This is especially true for all those whose circumstances have changed for the worse. Some are simply aware that they need coverage, with no clue as to how to go about its acquisition.

Here we will look at some of the important considerations for first timers, as well as the importance of the Open Enrollment period. We will look at the changes to the Enrollment Period and some of the concerns that many applicants have regarding changes to the Affordable Care Act.

What is the Health Insurance Marketplace?

(Source: IXSolutions)

This is an important question for all those that have never had to apply for personal coverage before. This marketplace may be nationwide, with millions of users, but some Americans won’t be familiar with the process. This is a resource for all those that are in need of some form of health insurance coverage not provided through other means.

This is an important question for all those that have never had to apply for personal coverage before. This marketplace may be nationwide, with millions of users, but some Americans won’t be familiar with the process. This is a resource for all those that are in need of some form of health insurance coverage not provided through other means.

You may be new to the process because you previously qualified for Medicare, Medicaid or CHIP (the Children’s Health Insurance Program). Those that lose their jobs switch to a job with lower pay or benefits and those that come of age need a new program. The idea here is that you can shop around – in the marketplace of products – for the best option. Different insurers place themselves on the market with packages under the ACA. As you will see below, availability and choice can vary.

Does this access to affordable options mean that the Health Insurance marketplace is the best way to get a good deal on health insurance?

All citizens want the best-priced package that covers everything that they need, at an affordable rate. There are variations across the board, but this is a great resource for a better deal. Those struggling to find coverage, who are stuck in that middle ground between Medicaid and employer-based programs, can improve their circumstances. The costs and savings largely come down to income.

The majority will save due to the lower cost of the plans – around $50-$100 per month – and their income bracket. Others will not be so lucky. It is important to note at this point that those on Medicare (65 yrs and older) and those with job-based insurance will not get a better deal here. The packages are unlikely to be any better than those offered by employers and will cost more. Also, Medicare insurance members cannot switch to Marketplace insurance or have regular health insurance used to supplement current plans in any way.

How can you tell if you will be able to qualify for this coverage?

There are government tools that can help you understand your place within these brackets and the options available or speak with a licensed agent. Their simple calculator shows qualifications based on income, including potential qualifications for other programs. It can help with premium tax credits, CHIP coverage for your children and new Medicaid laws. Many states are expanding their Medicaid coverage to households under a certain threshold. There is a chance that your family may now qualify. However, new applicants should not get too complacent about these positive changes. This is because of additional new features that you will see below.

Children's Health Insurance Program

How can new applicants apply for these new health insurance policies?

This is a positive step toward affordable, accessible health care for many Americans. There are still those that have never applied before and don’t know where to start. There are four ways that you can talk to a licensend agent or a navigator to see what help and options are available.

The first is to fill out an application. This is a formal process, but one that may be daunting to those that are new to the system. The alternative here is to have your local insurance agent help you over the phone and/or online or see them in person.  This is great for more complex, personal cases that require a little more time. Then you can try to call the number listed on  to speak with Navigator (a representative) to explain your situation. These options are also great for those with mobility issues or other disabilities.

Applying for coverage in the Healthcare Marketplace in 2018

The Healthcare Insurance Marketplace has an Open Enrollment Period, and all applicants have this window to make their claim. The window for 2017 has long gone, so what can we do if we still require coverage?

Some of us will have to wait until the 2018 Open Enrollment Period. Others can try for a Special Enrollment Period or application via Medicaid or CHIP. Both Medicaid and CHIP offer a regular enrollment period so applicants don’t miss out on the potential for essential health care coverage.

Qualification for a Special Enrollment Period (SEP) will depend on your circumstances. For the most part, officials will look at recent life events that have a large impact on your home life and income. The recent loss of a job or health insurance plan may count. Then there are life events such as marriage, birth, divorce, and bereavement where the family unit alters.

Anyone dealing with one of these issues, or a major illness, should consider the possibility of this waiver for a new insurance plan. The government appreciates that these events bring new circumstances and needs, and may be lenient. Still, there is no guarantee that they will grant all requests. It is better to ask and face rejection than hold back and miss out.

The 2018 Open Enrollment Period for the Healthcare Insurance Marketplace

If you do not qualify for these options, you will have to wait until the 2018 period. This leads to many concerns from those confused about the future of affordable health care in the US. It is clear that President Trump is keen to overhaul the healthcare system entirely – replacing the Affordable Care Act or Obamacare. Therefore, there are worries for all those currently on the Obamacare system who don’t know if they will be able to enjoy the same coverage next year.

The good news here is that the pace of government reform is so slow, especially for a measure like this, that there shouldn’t be too much to worry about with this new enrollment period. If President Trump and the US Congress finally get their way with their reform bill, the changes are more likely to take effect in 2019 or later.

At the moment, all we have is an executive order to reduced “unwarranted economic and regulatory burdens” of the ACA. This is essentially a vague threat of future action and cuts. There is also the fact that the president has said that he wants to “let Obamacare implode” as a method of bringing the Democrats to the negotiations. Many criticize this move as reckless, and it, therefore, seems that the debate will rage on for a little longer yet.

Applicants are under the assurance that there will be ACA insurers in all counties of each state in America for the 2018 enrollment.

One piece of recent, positive news regards the confirmation that every county in the US will have at least one insurer in their ACA marketplace for the 2018 period. This means that there is an affordable option for everyone – in theory.

The deeper issue here, however, is a limited choice and increased competition. Every county has someone. But, that one provider could be the only provider in the area. One insurer does not equate to choice, and may not offer the type of package, or affordability that applicants are after. It also limits the chance of competitive pricing for the best deals.

In fact, experts estimate that 2.9 million may face this situation for the 2018 period. There are some states where this covers the entire state, or close enough, such as Iowa with 94 out of 99 counties on just the one ACA insurer. Others have more of a patchwork effect with different situations in neighboring counties. Overall, stats suggest that 23% of enrolling applicants will have access to just one ACA insurer, 26% will have a choice between two, 19% a choice between three and 32% get four or more.

Healthcare Marketplace 2018

So, when is the 2018 enrollment period?

This period was recently confirmed as running between the 1st of November and the 15th of December. This is the only time that applicants will be able to make their claim for the year ahead. Many will note that this seems like a short window for a lot of applicants, and such an important purchase for the year ahead. This is because the Centers for Medicare and Medicaid Services recently proposed that the enrollment window should shorten to just six weeks. Applicants should also be aware that any plans sold during Open Enrollment start precisely at the beginning of the year: January 1, 2018. They do not start from the date of an accepted plan.

What can citizens expect beyond this 2018 window regarding access to coverage and costs?

The 2018 enrollment period, although short, seems pretty solid regarding the options that applicants can expect. However, there are still uncertainties over changes during 2018 and the years ahead. There is that risk of reduced choice, especially as major providers remove their plans following financial and political issues. That reduction in ACA insurers mentioned above is often down to the political situation.

Insurers don’t know what President Trump will do, so don’t want to take any major risks. There is the idea that cost reduction methods would cut government subsidies on healthcare, forcing insurers to make up the difference. Few want this extra cost, so, therefore, take them out of the equation. We have to remember that this is about business at the end of the day.

The uncertainty of current plans and Obamacare means that many now choose to opt for a different approach. Long-term, full-coverage options seem like a bad bet if some of these elements, or perhaps even the entire plan, could disappear shortly. Therefore, many now see the benefit of switching to short-term plans and plans that only cover an accident or sudden illness. It is a temporary solution until the situation becomes clear. This is a problem for all those that rely on the marketplace for health insurance when it comes chronic, genetics and other pre-existing conditions and disabilities.

Research and preparation are essential for the best approach to the Healthcare Insurance Marketplace and open enrollment.

It is vital that all applicants without a plan in place make sure to apply within this short time window. There could be quite a rush at the start, as many try and get everything sorted out as soon as possible. This could put some strain on the staff and resources. However, you don’t want to leave it too long and miss out.

As you can see from the points above, there are clear benefits to this marketplace for those that struggle to find coverage. The insurance options may shrink in some counties, but they are still an accessible, affordable solution for many. It is also a great idea to research the situation further and the full process and options in signing up with the Health Insurance Marketplace. This also means developments on the ACA and the future of Obamacare. This research and an ongoing eye on the news can help you with informed decisions, and your interactions with the government.

Remember that the more prepared that you are for this Open Enrollment period on November 1 until December 15, the easier it will be. The more you know about the end of Obamacare and changes to Medicaid, the easier the transition in the future. There are uncertain times ahead for affordable healthcare in the US, but the 2018 enrollment period is happening. Make sure to get the best deal you can during those six weeks.

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