As an independent businessperson, I’ve been enrolled in health insurance through the Affordable Care Act practically since it went into effect. Due to an unprecedented buildup of bile, the current administration radically shortened the open enrollment period for plans offered on the ACA marketplaces, which will lead to somewhat fewer people enrolling in time for their coverage to begin January 1, 2018, despite an accelerated pace of enrollment during the shortened open enrollment period.
So, this being the last day of the open enrollment period, I wanted to give a quick, practical breakdown of all the options available.
If you’re self-employed or don’t get qualifying health insurance through your employer, then head to healthcare.gov right now and submit an application. If you estimate your 2018 income between 138% and 250% of the federal poverty line, you’ll likely be best off choosing a Silver plan, so you can take advantage of cost-sharing reductions. If your estimated income is up to 400% of the federal poverty level, you’ll still be eligible for a (decreasing) amount of advance premium subsidies.
Note that despite the current administration’s refusal to pay the cost-sharing reduction subsidies to insurance companies in a timely manner, the insurance companies themselves are still forced to honor them.
If you think you’re unlikely to use non-preventive medical services during 2018, another option is to use a premium subsidy to purchase a Bronze plan. Such plans don’t qualify for cost-sharing reductions, but still provide the preventative services offered by all ACA-compliant plans.
For most people, most of the time, the open enrollment period is the appropriate time to sign up for health insurance coverage for the following year. However, there are a range of exceptions which allow people to signup for ACA-compliant health insurance throughout the year.
Besides getting married or having children, the easiest exceptions to the open enrollment period are changes in residence. From healthcare.gov, such changes include:
- Moving to a new home in a new ZIP code or county
- Moving to the U.S. from a foreign country or United States territory
- A student moving to or from the place they attend school
- A seasonal worker moving to or from the place they both live and work
- Moving to or from a shelter or other transitional housing
While it may sound strange — and it is strange — to move your residence to a new ZIP code in order to trigger a special health insurance enrollment period, the reason it’s strange is because we don’t offer our citizens universal, comprehensive, affordable health insurance coverage.
Enroll in Medicaid
If you live in a Medicaid expansion state, you can enroll in Medicaid at any time if your income is or drops below the Medicaid eligibility threshold. That’s usually 138% of the federal poverty level, although Medicaid enrollment is administered by the states so enrolling can be as easy or hard as your state chooses to make it.
Health insurance isn’t about staying healthy. If you want to stay healthy, you should eat mostly vegetables, cooked mostly in olive oil (not too hot though!), get a moderate amount of exercise, and pray.
Enrolling in health insurance is about paying for all the things that lightly sautéed vegetables and cross-country skiing won’t prevent. So get covered — or at least have a plan to get covered.
If you end up needing medical care, you’ll thank me then. If you don’t end up needing medical care, I’ll thank you. Do we have a deal?