Thursday, November 1, 2018

Des Moines – The Affordable Care Act’s (ACA) open enrollment period begins today and ends December 15, 2018, for Iowans purchasing or changing their ACA individual health coverage to become effective January 1, 2019.

“Iowans looking for ACA-compliant health coverage should get in touch with a licensed agent to research their coverage options.  A licensed insurance agent can help Iowans determine the best plan for themselves and their families,” Iowa Insurance Commissioner Doug Ommen said. “For those needing individual coverage, Iowans have two carriers, Medica and Wellmark.  Iowans may go to healthcare.gov to review these ACA-compliant plans, which have varying deductible and copayment levels. The ACA tax credit subsidy system will produce affordable coverage for many Iowans whose household incomes fall below 400% of federal poverty level.”

“The premium increases for ACA-compliant plans have priced a significant number of Iowans out of the individual market,” Ommen said.  “With the help of a local insurance agent, consumers who do not receive subsidies through the ACA may have other more affordable options.”

Changes made at the Iowa state legislature and by the federal government have provided a few more health coverage options in addition to ACA-compliant coverage for Iowans.  A non-insurance health benefit plan sponsored by the Iowa Farm Bureau, a non-profit agricultural organization, also begins enrollment today.

Changes in state and federal laws also now allow business owners to form Multiple Employer Welfare Arrangements (MEWAs) and Association Health Plans (AHPs).  The Iowa Insurance Division is available to help assist associations working to form a MEWA or AHP so they may offer coverage to employees or members.

Local insurance agents, assisters, and certified application counselors around the state are available to help Iowans review which insurance plan may best fit their needs.  Iowans can find local help by visiting https://localhelp.HealthCare.gov/.

Iowans who wish to purchase ACA-compliant coverage need to complete enrollment by December 15, 2018, to have coverage effective by January 1, 2019. During open enrollment, Iowans may call 1-800-318-2596 or visit healthcare.gov for information regarding enrollment and to calculate applicable tax credits.  Healthcare.gov is the only official government website selling health insurance, and buyers should beware of imitation websites.

Most Iowans access healthcare in one of three ways:

  • Employer-Sponsored:  It is estimated that 1.6 million Iowans participate in employer-based health insurance plans. This includes employees of large and small private companies, federal, state and local government employees and active military.  Consumers in a small business should talk to a licensed insurance agent to discuss all available coverage options.
  • Public Programs: Roughly 1.2 million Iowans receive healthcare benefits through Medicare and Medicaid.
  • Individually-Purchased: In 2018, approximately 107,000 Iowans purchased health insurance on their own. About 39,000 Iowans remain in the individual ACA-compliant market.  An additional 68,000 continued coverage in a grandfathered or transitional policy.

Under each category, there are important developments and information consumers should keep in mind as open enrollment begins:

Individually-Purchased Health Insurance or Health Plans

  • Medica and Wellmark are offering ACA-compliant individual health insurance plans to Iowans statewide for plan year 2019.  Consumer price experience, tax credit implications, provider networks and cost-sharing provisions may vary depending on the plan level.  Consumers should carefully consider their options.
  • If you currently have coverage through the exchange and do not choose a plan for 2019 by the end of open enrollment, you will be re-enrolled into the same plan offered by Medica.

Employer-Sponsored Health Insurance

  • If you are already covered by an employer-sponsored plan, pay close attention to your enrollment options this year. Premiums and coverage limits may have changed.
  • If you are changing jobs, you may be subject to a probationary period, up to 90 days, during which you are not eligible for group coverage.
  • If you lost coverage from a previous employer, you typically have 60 days to enroll in private individual insurance through healthcare.gov under a Special Enrollment Period. If you have recently lost a job and access to employer-based insurance, you and your dependents may be eligible for continuation coverage under COBRA.
     
  • Consumers in a small business should talk to a licensed insurance agent to discuss all available coverage options.

Public Healthcare Programs

  • Medicare is a federally funded program available to most U.S. citizens and permanent legal residents age 65 or older who have lived continuously in the country for at least five years. People younger than 65 also may be eligible for Medicare if they are disabled, suffer from kidney failure or ALS (Lou Gehrig's disease). If you have questions about enrolling in Medicare, you can contact Iowa’s Senior Health Insurance Information Program at http://shiip.iowa.gov or call 1-800-351-4664.
  • Medicare open enrollment for Medicare Advantage and Medicare Prescription Drug coverage (Part D) is currently ongoing and ends December 7, 2018. If you miss the deadline and didn’t experience a qualifying event, you can apply during general enrollment (January 1 through March 31 of each year), though you will have to pay a premium penalty.
  • Medicaid is jointly funded by federal and state governments. Eligibility is means-based with state-based income requirements.   To see if you and your family are eligible for Medicaid, please visit the Iowa Department of Human Services at dhsservices.iowa.gov or call 1-855-889-7985.

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