Plus, What to Expect for 2018 Open Enrollment
The NFIB Health Insurance Exchange receives many questions about Open Enrollment, the Affordable Care Act, and health insurance in general. Here are some of the most common questions asked with helpful answers for each.
Q. What’s with the repeal and replacement of the Affordable Care Act (ACA)?
A. All efforts by the current Congress to repeal the ACA have failed. Therefore, the ACA will stay intact for now.
Q. What is the root of the problem?
A. There are many issues with the ACA, but one of the biggest is that the ACA does not control any medical costs related to hospitals and pharmaceutical companies. Many drugs cost over $200 a month now and some are $5,000+ a month. In addition, a short hospital stay can be $100,000 or more.
Q. With no repeal or replacement, what’s going to happen next?
A. The insurance companies are losing money on the exchange marketplaces, so many have left. Without insurer competition, costs increase even further and few choices exist. Many U.S. counties will have only one insurance carrier available in 2018. Large health insurance companies like UnitedHealthcare, Humana, Aetna, and even some Blue Cross organizations have pulled out of markets completely.
Q. Why are the insurance companies losing money and pulling out of markets?
A. The ACA requires that all insurance companies pay out at least 85% of the funds received or they must refund the money. The problem is many are paying out 100%,110%, or even 120%+ of funds received. When this happens, they do not get a refund for these excess payments and they still must refund money in places where claim payments were lower.
Q. What about people that have pre-existing conditions in the future?
A. A full repeal would take away coverage from some people, but not the majority. However, another option could be to have one less expensive product that you must qualify for and one more costly product that has no qualifications. The product with no qualifications would still offer subsidies to help with premium payments, making it more affordable.
Q. Do I have an ACA plan now? I don’t receive any subsidies so that’s not an ACA plan, right?
A. In most cases that’s false. If you have an individual market plan you may have an ACA plan. Most private plans, subsidized or not, on the individual market are regulated by the ACA and must be compliant with the law. Just because you don’t qualify for a premium subsidy doesn’t mean you don’t have an ACA-compliant plan. For example: If you have a private Blue Cross plan not sponsored or paid for by your employer, there is a very good chance this is an ACA-compliant plan.
Q. Are there other options available to me if I don’t like the ACA plans offered during the 2018 Open Enrollment?
A. The NFIB Health Insurance Exchange currently has and is working with several other carriers to offer non-ACA plans, like term medical and fixed annuity, for 2018. These plans have far more doctors and hospitals available, and premiums in most cases will be half the cost of the ACA-compliant plans. Plans will be available in most states and counties in the U.S.; however, availability may vary and certain state exclusions may apply.
Q. Will I have to pay a tax penalty for buying one of these non-ACA plans?
A. The non-ACA plans do not meet the minimum essential coverage requirements under the ACA and may result in a tax penalty. However, you should always consult with your tax advisor on tax matters.
To learn more about health insurance options and other products that may be available to you, visit the NFIB Health Insurance Exchange.