Betty Lin-Fisher: Healthy Actions: What you need to know about Affordable Care Act health insurance plans open enrollment

Oct. 27--This month's Healthy Actions column covers common questions and answers about the upcoming open enrollment period for health insurance plans through the federal Health Insurance Marketplace.

The plans were created through the Affordable Care Act, also known as ACA or Obamacare.

The ACA plans are available for those without health insurance through a job, Medicare, Medicaid or other source. This year, 11.8 million consumers are covered by these plans, including 230,127 Ohioans. That's down from about 12 million Americans, including 238,843 who were enrolled in 2017.

My experts this month are Heather Gunnoe and Lori Jensen, certified application counselors for AxessPointe Community Health Centers. The federally supported community health centers are continuing to offer free counseling to help people apply for ACA plans even though the federal funding for the services has stopped. Anyone can use AxessPointe's counseling services, not just patients.

The ACA remains a hot political issue, while advocates say health-care needs for consumers are being lost in the shuffle. New next year is the elimination of the financial penalty when consumers file their taxes if they do not carry health insurance. That could affect the number of people who sign up for an ACA plan since the previous rules required everyone to carry health insurance or show proof, Gunnoe said.

Here are some common questions and answers about the ACA, as answered by Gunnoe and Jensen:

Q: How were the Affordable Care Act health plans created?

A: The ACA is a law passed in 2010 and implemented in 2013 for the January 2014 enrollment period. The enrollment for 2019 is the sixth open enrollment period for the ACA plans. The original open enrollment of six months was cut back to three months until last year, when it was halved again to only 6 weeks. There will be no federal advertising provided and no public service announcements.

Q: Who can apply?

A: Most people are eligible to apply; however, not everyone is eligible for extra help paying for coverage. Some restrictions apply, such as receiving Medicare or Medicaid. Ohio is a Medicaid expansion state, meaning eligibility was widened to cover more people. . If an individual or family is eligible for Medicaid under expansion, they will be referred to the County Department of Jobs and Family Services. Immigrants who are here legally are eligible for ACA insurance and must provide proper immigration paperwork. To get coverage under Medicaid expansion, they must be in the United States for five consecutive years.

Q: When can I apply?

A: You must apply during open enrollment, which this year begins on Nov. 1 and ends on Dec. 15 for coverage beginning Jan. 1, 2019. After Dec. 15, enrollment requires a qualifying life event. Plans are available through an online marketplace at www.healthcare.gov.

Q. What is a Special Enrollment Period?

A: A Special Enrollment Period (SEP) is a period of time outside of open enrollment when consumers can enroll in coverage or change their plan. A qualifying life event such as loss of health coverage, changes in household, changes in residence and other qualifying events. If a person loses a qualified health plan, they have 60 days to be eligible for a Special Enrollment Period. The loss must be involuntary (such as loss of job, divorce). Voluntary loss of coverage does not qualify. See www.healthcare.gov for a complete list of qualifying life events

Q. When will my coverage begin?

A: The effective date of coverage can be specific to the insurer's discretion. Generally, if you pay your premium on or before the 15th of the month, your coverage starts the first day of the following month. If it is after the 15th of the month, it is delayed until the first day of the second month. There are exceptions. The completed application will list the first date of coverage.

Q. How much is this going to cost me?

A: There are five different types of coverage: bronze, silver, gold, platinum and catastrophic (for those 30 or younger). You can apply for a tax credit for any level of coverage, but only silver plans have cost saving reductions to assist with out of pocket expenses, such as deductibles. All plans have a maximum out-of-pocket cap, meaning once you have paid that maximum, the plan will pay 100 percent.

Q. What happens if I don't have coverage?

A: When you file your 2018 taxes in 2019, you will still have to file the proof of insurance coverage and reconciliation for 2018. For the tax year 2019, which will be filed in 2020, health insurance is not required; therefore, there will not be a penalty.

Q: What are the monthly premiums?

A: According to the Kaiser Family Foundation analysis, premiums for an Ohio 40-year-old nonsmoker after receiving the tax credit will increase 2 percent for the average Silver plan to about $206 a month. The same consumer will see an average 8 percent increase for gold plans, averaging $279 a month, and 13 percent for bronze premiums, averaging $143 a month. The study said 63 percent of enrollees are in silver plans.

Q: If I had a plan last year, does it roll over?

A: It depends. You may get a letter from your current plan, but it's important that you renew your application on Healthcare.gov to ensure you receive premium tax credits and cost-share reductions for next year, even if you are staying with the same company. If you don't act, you will pay whatever premium the company is charging you, which could be higher than what you will get from that same company on Healthcare.gov.

Q: I've read a lot that politicians want to get rid of the Affordable Care Act. Does that mean I'll lose my coverage?

A: If you have enrolled in coverage for 2019, you will have it until Dec. 31, 2019, regardless of what happens with the law.

Beacon Journal consumer columnist and medical reporter Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ and see all her stories at www.ohio.com/betty

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