Bulletin: Changes for Open Enrollment in State Health Insurance Exchanges

 

The Affordable Care Act (ACA) established state health insurance Exchanges to purchase individual and family health insurance coverage.  This TCHS Bulletin highlights changes from previous years and other important consumer information when signing up for health insurance during open enrollment November 1st to December 15th, 2019 – the only opportunity (except in California, Colorado, and Washington, DC, Massachusetts, Minnesota, New York, Rhode Island, which allow more time) to obtain coverage that will start January 1st, 2020.



The Affordable Care Act

The Patient Protection and Affordable Care Act, often referred to as the Affordable Care Act, ACA or Obamacare, is a 2010 federal law established to expand Medicaid, make health coverage more affordable for people through subsidies, and lower costs of healthcare by utilizing innovative methods for medical care. 

State Exchanges for Individuals

Through a state-by-state marketplace called an Exchange, individuals are able to sign up for health insurance coverage. Open enrollment period for the 2020 marketplace will be from November 1, 2019 to December 15, 2019.

Individuals who do not have health coverage can sign up for government insurance through Medicaid (if they qualify based on income) or purchase it through the Exchange in their state.  There are subsidies and tax incentives available on a sliding scale for health insurance purchases in the State Exchanges.

Plans in the new State Exchanges will be offered by private health insurers, and every plan will cover a core set of benefits called essential health benefits.  These benefits include prescription drugs, mental health, substance abuse treatment, and rehabilitative services, among others. Individuals can compare their options based on price, benefits, quality, and other important features. 

Many people will qualify for tax incentives when purchasing private insurance coverage in the State Exchanges. Others will qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).  By filling out one State Exchange application, an individual will be referred to the appropriate program and incentives

Tax Credits

Financial assistance is available only in state Exchanges and healthcare.gov for those who qualify for the Advanced Premium Tax Credit (subsidy). This “advance” or subsidy reduces the monthly premium for health insurance. As of 2020, eligibility for the Advanced Premium Tax Credit (subsidy) is available for individuals making between $12,490 to $49,960, or a family of four making between $25,750 to $103,000 annually for the year of 2020.

Penalties 

Under the current administration, the individual mandate has been repealed at the federal level. As a result, individuals who DO NOT purchase health coverage for the year of 2020 will NOT have to pay a fine unless there is a individual mandate at the state level.

Health Insurance Requirement

As of 2020, the following states have an individual mandate:

  • Massachusetts
  • New Jersey
  • Vermont
  • California
  • Rhode Island 


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