Looking To Cover Your Pregnancy & Baby Costs? Here'S What You Need To Know About 2018 ACA Open Enrollment
If you’re signed up for health insurance through the Affordable Care Act (ACA), open enrollment this year starts November 1 and lasts through December 15. With all the changes lately, you’re probably wondering what the impact will be on your family. While there are some important changes in 2018, you do still need to sign up for health insurance, and you will still get the same coverage and financial aid. Here’s what moms-to-be need to know about ACA open enrollment.
First, a little refresher on the basics of health care under the ACA:
There are four levels of plans
Health insurance plans still come in four standard levels, which each cover a different percent of your medical expenses: Bronze, (60 percent); Silver (70 percent); Gold (80 percent); and Platinum (90 percent). Bronze plans have the lowest premiums (the amount of money you pay every month just to keep the plan); the more your plan covers, the more you’ll usually pay in premiums — although that may change this year (more on that below). Silver plans are the only ones you can choose to get cost-sharing subsidies.
It’s critical to review your options
"Moms and expecting moms are really going to want to look not just at premium cost but out-of-pocket cost," says Sandy Ahn, Associate Research Professor at the Center on Health Insurance Reforms at Georgetown’s Health Policy Institute. "If you use your plan a lot, you need to do more of a comparison of your out-of-pocket max, deductible, co-pay and co-insurance," especially if you don’t qualify for a lower cost-sharing plan. Some plans, for example, have a $6,000 deductible — i.e., the amount you have to pay before your health plan starts covering non-preventative services. That means you’ll be shelling out a lot of money before your insurer kicks in and starts paying for your prenatal visits and birth, and you might be better off paying a higher monthly premium to get a lower deductible.
Maternity care and well-child visits are covered
As with years past, all plans on the marketplace must cover a number of essential benefits, including prenatal care, newborn care, pediatrician visits, well-woman visits and medications.
Preventive care is still free
Some services come at no cost to women and to children (meaning you owe no co-payments or co-insurance, even if you haven’t met your deductible):
- Pregnancy screenings (for gestational diabetes, anemia, Rh incompatibility, etc.)
- Folic acid supplements
- Breastfeeding assistance (a free breast pump and help from a lactation consultant)
- Birth control (Trump’s recent exception, which allows companies to opt out of covering birth control for their employees, doesn’t affect marketplace plans)
- Vaccinations, including the flu vaccine
- Well-baby and well-child visits
You can get financial help
Help is still available to make your health insurance less expensive. "Nothing has changed for the consumer," says Ahn. "Insurance companies still required by law to provide cost-sharing subsidies to consumers whether or not they get federal funding."
That means if you earn up to 250 percent of the federal poverty level, you can get a cost-sharing reduction. These extra savings lower your deductibles and co-payments and your out-of-pocket max (the total amount you have to spend on medical services in a year) — but you have to sign up for a silver plan. If you make up to 400 percent of the federal poverty level, you qualify for tax credits to help pay for premiums. The amount you get is based on your income and the cost of a silver plan (although you can sign up for any level of plan). See if you qualify for extra savings at healthcare.gov.
You can find a plan no matter where you live
There is at least one health insurance provider offering marketplace coverage in every area of the U.S.
Health insurance is still mandatory
The penalty for not having health insurance is still in place. The fee is calculated in two different ways: as a percentage of your income (2.5 percent of your annual family income) or per person ($695 per adult and $347.50 per child under the age of 18). You pay whichever is higher.
You can get help choosing a plan
Overwhelmed? You don't have to do this alone — trained local "navigators" are available in places like libraries, public health centers and churches to provide free, in-person help. Find your local resource by entering your zip code at the health care marketplace website. Be aware that funding for this program has been cut, so your best bet is to contact your community navigators as early as possible.
Changes Moms Need to Know About
With that said, there are a number of important changes all new moms need to be aware of:
Open enrollment is shorter
Open enrollment is the only time you can sign up or change your health care plan — and this year it’s six weeks shorter than last year, lasting from November 1, 2017 to December 15, 2017. New policies start on January 1, 2018. (If you live in one of 15 states that runs its own marketplace, you may be able to sign up through the end of January.)
"[Last year] if you were automatically re-enrolled in January and you didn’t like your plan, you had the opportunity to change plans through the end of January," says Ahn. "This year there’s one deadline, on December 15, and in January you won’t be able to change plan unless you qualify for special enrollment." With less time to weigh your options, it’s smart to start the process as soon as you can.
Healthcare.gov will be shut down for maintenance at times
Something else to be aware of: Healthcare.gov will be shut down on Sundays from 12 a.m. to 12 p.m. EST for scheduled maintenance (with the exception of December 10), meaning that the site will be completely offline at those times.
Your premiums may very well change
You should always check your plan to see if the costs, benefits or providers have changed and to compare it to other options. That’s especially true this year given premiums might change.
Trump’s executive order, which cancels payments to insurance companies for cost-sharing subsidies, needs to be approved before it becomes law. However, insurers have already hedged their bets — and many companies have already bumped up some premiums for 2018 plans. Depending on where you live, most of these changes were only made to silver plans, which are tied to subsidies. If you qualify for a subsidy, the amount you get will increase at the same time your premiums go up, so you won’t notice the difference. "You may see premiums go up on and off the marketplace. But if you qualify for cost-sharing subsidies, the amount you get is tied to increase in the cost of plan," explains Ahn. You will notice changes, however, if you don’t benefit from the subsidies — which might mean you’ll find a cheaper plan off-marketplace.
Bottom line: "Make sure you go back and shop. It’s technical and depends on where you live. But your premium tax dollars may give you the ability to buy a higher metal level plan," Ahn says.
If you need to change plans, you may have more time
If your current plan is being discontinued — meaning your insurance doesn’t offer it next year — you may qualify for a special enrollment period (SEP), which extends the amount of time you have to sign up for a plan until the end of February. Once you do apply for special enrollment, you have 30 days to submit verifying documents before you can enroll in a plan.
You have narrower options under special enrollment
While you might have more time to choose your plan if you qualify for special enrollment, you might not want to wait: Going through special enrollment narrows your options, because you’ll have to pick a plan in the same metal level as your current one. "Even if you know your plan is being discontinued, it might be better to shop during open enrollment," says Ahn.
Likewise, while giving birth is an event that qualifies for special enrollment, your family can no longer change plans the way you could have in the past. "You can add your child to an existing plan or pick a separate plan for a child, but you can’t change plans for yourself," says Ahn.
She does note one exception: If having a baby qualifies you for cost-sharing reductions on a silver plan, but you're not already on one, you can all switch as a family to a silver plan. Lastly, Ahn highlights that for the most part, pregnancy does not qualify you for SEP — with the exception of New York, where you have a few different health insurance options even after open enrollment ends.
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