Before the Patient Protection and Affordable Care Act was made law, there were various rules regarding health insurance application processes to control costs so that health insurers could accept more healthy people while managing the costs associated with sicker people in their pool.
Open Enrollment Period
Open enrollment is the period each year when people can enroll in Obamacare and make changes to their existing coverage. It provides an excellent opportunity to find insurance that meets your individual needs and budget.
The Open Enrollment Period for Obamacare plans typically runs between November 1 and January 15 each year, although many states offer extended enrollment periods so people have enough time to sign up.
These states include Connecticut, Idaho, Maryland, Nevada, Rhode Island and Washington.
Nearly 1.8 million more people have signed up for 2023 health insurance coverage through Marketplaces this year than at this point last year, including nearly 3.1 million new Marketplace customers and 12.8 million returning consumers who selected or were automatically reenrolled into coverage via an automated renewal.
The Affordable Care Act Marketplaces continue to flourish, providing affordable health coverage to over 14 million Americans. Marketplaces also continue providing subsidies that have been enhanced under the Inflation Reduction Act of 2018.
Special Enrollment Period
If a qualifying life event arises, you may qualify to enroll in an Affordable Care Act-compliant plan outside of the annual open enrollment period. A special enrollment period (SEP) could last for up to 60 days after its occurrence.
Life events such as losing coverage, outgrowing an existing policy, moving states or getting married typically trigger special enrollment periods for health insurance plans. Other circumstances may qualify you for this form of health coverage as well.
HHS recently announced a special enrollment period for individuals earning below 150% of the federal poverty level (FPL), giving those eligible for premium tax credits the chance to enroll in a benchmark plan with subsidies covering part or all of its cost.
Employer-Sponsored Plans
Employer-sponsored plans provide employers with a way to offer various retirement savings and health insurance plans to their employees, often at tax savings benefits that help attract and retain qualified candidates.
Under the Affordable Care Act, employers with 50 or more full-time employees must offer minimum essential health coverage to at least 95 percent of full-time employees or pay a penalty fee. Businesses with fewer than 50 workers do not fall under this mandate.
An Employee Benefit Research Institute survey recently found that many large employers utilize employer-sponsored health plans as part of their benefits strategy to control costs associated with employee healthcare and streamline overall benefits offerings.
However, certain policies and changes to the law could threaten this linkage between employment and health insurance benefits. Some policymakers are exploring the idea of including a public option into Affordable Care Act exchanges as one potential threat to its continued strength.
Medicaid
Medicaid is a joint federal-state health insurance program for low-income people that helps millions of Americans pay for routine and acute medical services, long-term care for older adults and people with disabilities and reduces out-of-pocket expenses.
Medicaid enrollees typically access their benefits through private managed care organizations (MCOs). While others receive traditional fee-for-service coverage from state agencies.
The Affordable Care Act expanded Medicaid eligibility, giving states more options for covering low-income adults and children under 65. Eligibility criteria vary based on both family’s income and resources.
