Healthcare reform has been a recurring hot topic, but no more so than in the last several years. Many people are confused as to what healthcare changes have occurred – and are slated to occur – in this evolving landscape. Here is a quick look at what has changed, what has remained constant, and what you can expect go forward. The following remarks apply primarily to individual market health insurance. Let’s start with the Affordable Care Act (ACA). Has it been repealed?
ACA Still in Effect
Despite nearly daily headlines (pre-COVID-19) indicating the looming threat of ACA being repealed or replaced, this has not happened as of this date. There is ongoing judicial action, however.
In December 2019, an appellate court ruling in the Texas v. U.S./Azar lawsuit struck down the ACA. The parties to the case are 18 GOP-led states as plaintiffs, and Democratic-led states defending the ACA. (The U.S. Department of Justice has refused to defend the ACA.)
The lawsuit states that as ACA’s individual mandate tax/penalty was eliminated in 2018, he mandate is no longer constitutional . The plaintiffs also claim that the mandate is not severable from the rest of the ACA. Therefore if one aspect is eliminated, the entire ACA must be found null and void. A federal judge agreed with the plaintiffs at the time, but the ACA has not been changed during the appeals process. The penalty repeal took place in January 2019. This action resulted in the federal penalty for being uninsured being eradicated in most places. Massachusetts, New Jersey, and DC have their own individual mandates, with penalties for non-compliance.
California and Rhode Island were expected to enact mandates in 2020. Individuals in those states will have to file an exemption or pay a penalty when filing taxes.
Remainder of the ACA In Place
Other than the individual mandate penalty repeal the ACA is still in effect. Average premiums increases have leveled out significantly, only rising 3% in 2019 and not at all in 2020. Average premiums for the benchmark plan are actually decreasing by 4% for 2020 in the 38 states utilizing HealthCare.gov. The reduction in benchmark premiums is credited to new insurers entering the individual markets, and price reductions from some of the existing insurers.
There are significant differences from one region to another, but as a rule benchmark premiums are dropping while overall average premiums are remaining flat. The market stabilization rule implemented in 2017 remains in effect in 2020.
- In most places, open enrollment runs from November 1 to December 15, with all plans effective January 1 of the coming year.
- If your policy was canceled for non-payment in 2019 and you’re looking to re-enroll with the same insurer, they are permitted to require payment of your past-due premiums before starting your new coverage.
- Benefit and coverage changes in the individual and small group market apply for 2020 just as they have in past years, with adjustments to deductibles and out-of-pocket limits, along with provider networks and covered drug lists.
- In 2018, the Trump administration made changes to short-term limited duration health plans (STLDI), making the plans more available as substitutes for traditional ACA-compliant individual market health insurance. There are 11 states where no short-term plans are available, and multiple other states where short-term plans are available but have restrictions, so be sure to check with your local insurance broker for what rules apply in your area.
At Anderson & Associates Insurance Group, we stay up to date with the latest changes in health insurance so you don’t have to . Call today for a consultation or no-obligation health insurance quote.
