Shopping for Affordable Care Act health insurance for 2022? What you need to know [Akron Beacon Journal]

Consumers shopping for health insurance plans under the Affordable Care Act could find cheaper premiums for next year, thanks to pandemic relief efforts.

The open enrollment period for consumers shopping for health insurance plans under the Affordable Care Act begins Monday, Nov. 1.

Open enrollment continues through Jan. 15. That is two weeks longer than previous years, but if you want coverage to begin on Jan. 1, you must enroll by Dec. 15, said Steph Pugh, a certified application counselor with Lifecare in Canton, a federally qualified health center. Enrollments after Dec. 15 through Jan. 15 would start coverage on Feb. 1, she said.

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

This is the ninth annual open enrollment for the ACA plans, which are available for those without health insurance through a job, Medicare, Medicaid or other source.

This year, 12 million consumers — including 201,069 Ohioans — signed up or were automatically re-enrolled in these plans. Enrollment for this year was up 5% from the previous year's 11.4 million enrollees nationwide and 196,806 in Ohio.

Additionally, another 2.8 million Americans signed up for health insurance under the Affordable Care Act during a six-month special enrollment period earlier this year that President Joe Biden enacted to help people find coverage during the coronavirus pandemic.

Typically, consumers are only able to shop for a new plan outside of the yearly open enrollment period for 60 days after a "life event," such a marriage, divorce, new child, a move or employment change that results in a change to health coverage or loss of coverage.

The ACA remains a hot political issue.

The American Rescue Plan has expanded the availability of financial assistance for coverage through what's called the Marketplace, or www.healthcare.gov, "making financial assistance available to more consumers and at greater levels," according to the Centers for Medicare and Medicaid Services.

"These benefits continue from 2021 into 2022, and are available to eligible new consumers and to consumers returning to the Marketplace to shop for 2022. In part as a result of the ARP, four in five consumers will be able to find health care coverage for $10 or less per month," CMS said.

The following answers are provided by experts at AxessPointe Community Health Centers, a federally qualified health center in the Akron area that offers free help applying for ACA plans. Those seeking help do not need to be current clients of AxessPointe.

This year, the community health workers at AxessPointe took training to become certified application counselors so they could more directly help clients they work with, said Marihelyn Horrigan, community impact manager who oversees the workers.

"There are many times when people will come in and yes, they need insurance, but they have a lot of barriers and social determinants of health that need to be addressed, along with getting health insurance," said Horrigan. "We are able to engage the person and give more well-rounded care."

A: Most people are eligible to apply; however, not everyone is eligible for extra help paying for coverage. Immigrants who are here legally for five years are eligible for ACA insurance. AxessPointe has counselors who work specifically with the immigrant community.

A: Again this year, there is a large marketing push by private health care plans, some of which do not offer the same protections under the ACA rules. Some could turn you down or charge you more if you have a pre-existing condition — protections that are included in the ACA plans.

Be sure to know what coverage you are buying. ACA-compliant plans offer the most benefits. That includes what's called the 10 essential health benefits, such as coverage of preventive services like mammograms, pregnancy and newborn care, mental health and addiction services and prescription drug coverage.

Private insurance websites may not show all plans that you would find on www.healthcare.gov, the official site for enrollment in ACA plans. There are many look-alike websites.

Additionally, Horrigan cautions against only choosing a plan based on online, TV or mail advertisements or door-to-door people. In some cases, some services that are important to you may not be covered, she said.

"Don't navigate this alone," she said. "Have someone there with you and be wary of scams and read the small print."

A: Costs vary according to plan, family demographics, income and ZIP code. There are tax credits available for some consumers, based on household income. All plans have a maximum out-of-pocket cap, meaning once you have paid that maximum, the plan will pay 100%.

For 2022 plans, the average national benchmark premium for a 27-year-old is going down by 3%, to $368 per month from $379 per month, according to a recent report by the Centers for Medicare and Medicaid Services. That compares to a decrease of 2% the previous year.

A: No. Congress eliminated the federal tax penalty for not having health insurance as of 2019. However, if you choose to go without insurance, you cannot enroll in the ACA plans until the next November's open-enrollment period unless you have a qualifying life event, such as loss of coverage, getting married or having a baby.

A: It depends. You may get a letter from your current plan. It is important to update your application on Healthcare.gov to ensure you receive 2022 premium tax credits and cost-share reductions, even if you are staying with the same company. If you don't update your application, the automatic renewal rates can be much higher than what you can get by signing up for that same plan on Healthcare.gov.

A: If you have enrolled in coverage for 2022, you will have it until Dec. 31, 2022, regardless of what happens with the law.

A: Information about available plans in your area and enrollment can be found at www.healthcare.gov or www.CuidadoDeSalud.gov for information in Spanish. Additionally, consumers can call the Marketplace Call Center at 800-318-2596 for assistrance or to enroll. Also, see the accompanying story for additional local resources.

Also, Kaiser Family Foundation provides a lot of information. See a list of frequently asked questions at www.kff.org/health-reform/faq/health-insurance-marketplace-aca/

Beacon Journal staff reporter Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ. To see her most recent stories and columns, go to www.tinyurl.com/bettylinfisher.

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