Wednesday, November 16, 2016

What Now? Post-Election Questions about Enrolling in Affordable Care Act Coverage

By Sandy Ahn, Sabrina Corlette, and JoAnn Volk
President-elect Trump has promised to repeal the Affordable Care Act (ACA). However, the ACA is a complex law with many provisions. Repealing it will require both time and a process, including congressional action. There are actions the Trump Administration could take on their own, such as eliminating cost-sharing subsidies to lower out-of-pocket costs for eligible consumers. Until further action, however, the ACA is law and is operating. But that doesn’t mean that thousands of consumers won’t have questions about whether they can continue to enroll in coverage and how secure it will be once Trump takes office. For Navigators and others assisting consumers during this open enrollment season, we provide possible responses below. The bottom line? During open enrollment, now until January 31, 2017, consumers have a right to sign up for 2017 coverage. If they want health insurance in 2017, the time to sign up is now.
1)     If I sign up for coverage now, will I be able to stay enrolled if the ACA is repealed?
Yes, for coverage through 2017. The ACA is current law and in general, insurers participating on are required by federal and state law to continue providing coverage throughout the year. You have a right to purchase health insurance for 2017 now during open enrollment. You must sign up for 2017 coverage by December 15, 2016 to have your coverage start on January 1. If you miss the December 15th deadline, you have until January 31, 2017 to sign up although your coverage won’t start until February 1 or March 1, depending on when you signed up in January.
2)     I heard I might lose cost-sharing subsidies, is that true?
Possibly. The new administration could decide to discontinue the cost-sharing reduction payments to insurers. However, insurers are still obligated under the Affordable Care Act to provide those cost-sharing reductions to eligible enrollees, even if they are not ultimately compensated by the government. That said, instead of continuing to provide that coverage (and lose money), some insurers may discontinue those policies. If they do so, they must follow federal and state laws regarding notice to enrollees and the guaranteed renewability of policies. Under federal rules, if an insurer terminates a marketplace plan, it must offer you the opportunity to renew your coverage in the same plan, without subsidies, that’s sold outside of the marketplace. If your insurer decides to discontinue its plans both on- and off-marketplace, then it must provide you with written notice at least 90 days before the discontinuation of coverage, and give you the option to enroll in any other plan offered by the insurer. You would also qualify for a special enrollment period to select another marketplace plan, with subsidies, or to enroll in any other insurer’s plan outside the marketplace. State laws regarding plan terminations may also apply. For information on your specific state, please see Table 1 of our Navigator Resource Guide for a complete list of states and their department of insurance websites. These FAQs are also available on our Navigator Resource Guide at FAQ 1.3.6 and FAQ 1.5.26.

No comments: