Big changes are coming to Obamacare coverage. Here’s what your clients need to know for 2018.
Congress’ ongoing debate over a new healthcare law has no doubt created confusion among your clients about what shape their health coverage will take next year. Assuming Congress reworks and passes an Obamacare replacement in the coming months (which is far from certain), regulators may decide to impose new mandates immediately or phase in implementation over several years.
With moderate and conservative Republicans still wrangling over details, a final version has yet to be written and voted on. Until more these details materialize, agents must advise clients on the current marketplace under the Affordable Care Act (ACA) rather than speculating about what might happen in the future.
Recently, the Centers for Medicare & Medicaid Services (CMS) issued revised guidelines for ACA enrollment for 2018. If any of your clients are currently covered under the ACA or may need to apply for an exchange plan in 2018, they should be aware of these four significant changes that could impact their health insurance going forward.
Shorter Open Enrollment Period
Unlike previous years, when the open enrollment extended for three months, the CMS has reduced the sign-up period to 45 days — November 1 to December 15 — for coverage beginning on January 1, 2018. The CMS reasons a shortened open enrollment period will pull healthier people into the risk pool and discourage individuals from only applying for coverage when they face a major health crisis. So be sure your clients know they have less time to sign up for 2018 coverage. Otherwise, they could find themselves without health insurance for an extended period — maybe a whole year.
More Documentation Needed for Special Enrollment Periods
The ACA permits individuals to sign up for insurance or make changes to their current policy during special enrollment periods (SEPs) that fall outside open enrollment if they encounter a major life change — marriage, a new baby, job loss, etc. Although SEPs will continue, the revised CMS guidelines require individuals submit additional documentation (a birth certificate, for example) to verify those events. Your clients have 30 days to provide such documentation, which can be uploaded to HealthCare.gov or sent by mail. Help your clients collect the relevant documents so they don’t experience a lapse in coverage
Pay Up Premiums
Revised CMS rules stipulate that all unpaid premiums must be settled before an individual can purchase a new policy. In the past, insurers could terminate enrollees for failure to pay premiums. But if that same enrollee applied again for coverage after the lapse, insurers had to provide that person with a policy without the debt being paid. Now, insurers are permitted to apply unpaid premiums to a policyholder’s new contract, thus ensuring the exchanges get any money owed. According to the CMS, individuals “would generally owe no more than three months of premiums.” This new rule reinforces the importance of your clients never missing a premium payment. Not only could they lose coverage, but they’ll be liable for higher premiums if they want to buy another policy as well.
Limited Ability to Switch Plans
Your client can add another dependent to a qualified health plan (QHP) during the SEP. However, if the QHP’s rules disallow the dependent from being included in the plan, the enrollee and the dependent may sign up with another QHP as long as that plan provides similar coverage to the previous plan. If your client was enrolled in a silver plan, his or her new plan must be classified as silver. This revision, according to the CMS, prevents enrollees from using the SEP merely as a means to switch or improve coverage levels during the year.
With these revisions, the CMS hopes to spur people to continue their healthcare coverage so no individual faces a medical emergency without insurance. Convey that same message to your clients. Advise them of these rule changes to ensure they have proper coverage in place when the need arises.