Open enrollment begins for health insurance
Organizations like the
"It's been in the news a lot and there is a lot of confusion out there," said
Several efforts have been made to repeal and/or replace "Obamacare," but they have failed. President
But, Kelley said, there is still a network of navigators and certified application counselors out there who stand ready to help. And that's good news for the more than 3,000 individuals combined in
The bottom line
Much has been made of the soaring costs of premiums for plans in the Marketplace, with many areas in
Few users, however, actually feel the full brunt of that increase thanks to premium tax credits. The maximum tax credit is based upon a formula that brings the cost of a silver level plan's monthly premium to
According to a study by the
The figure is even higher in
The tax credit can be applied to the monthly premium of any Marketplace plan. For example, a 40-year-old non-smoker with an annual income of
CMS data shows northeast
Cost jump causes
There are a number of reasons for the increase in plan costs, many of which are self-inflicted.
"Insurance is the sharing of risk," Kriegshauser said. "This year's enrollment period is half as long. If fewer people sign up, there are less for sharing the risk, and it's more expensive for the folks bearing it."
Another is the
The benefits of the cost-sharing reduction payments, however, remain in place. CSRs provide reductions in copays and deductibles on certain silver level plans.
"The good news is for the end consumer purchasing the plan that qualifies, they still qualify and still get them. The difference is the insurance companies aren't getting reimbursed," Kelley said.
PPO vs. EPO
In prior years, PPO, or Preferred Provider Plans, dominated
Designed with an "open network" of providers, PPO plans carry a list of preferred health care providers under which a higher percent of costs will be covered. Visiting a doctor not "in network" would still provide insurance coverage, but a larger share would be paid by the consumer.
In 2018, however, Missourians will find no PPO plans. All 90 plans offered statewide are EPOs, or Exclusive Provider Network plans, which typically only provide coverage if health care services are performed by an "in network" entity.
"You cannot go out of network. You have to use the doctors and facilities that are in your plan. If you go out of network it's 100 percent on you. There's no cost sharing or anything like that," Kelley said. "It doesn't necessarily mean it's a smaller network, but the network is the network and that's it."
Kelley said it's important for consumers to look beyond the "sticker price" on the healthcare.gov plans. Information is available that lists physicians, facilities and medications that the different plans cover.
Get started early
In addition to slashing the enrollment period in half, the federal government has also stated that healthcare.gov will have planned outages every Saturday starting at midnight until as late as noon Sunday. Visitors will be able to browse plans and information but not complete any enrollment steps during those times.
Kelley said people should seek help and plan to enroll early, as a deadline extension this year is unlikely and website traffic should only intensify as
Kelley encouraged those looking for help to call 1-800-466-3213, or visit findlocalhelp.covermissouri.org, to find local assistance and be able to set up appointments.
If attending an appointment for assistance, individuals should have a working email address, accurate personal income information and
The ACA remains the law and its insurance plans will remain in place through at least the end of 2018. Most of those who do not have health insurance either through a private insurer or the government will face a tax penalty.
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