Do you need to know about changes to the health insurance marketplace regulations and how they impact you?
While the health insurance marketplace is simple enough to use, the regulations around it can seem overwhelming. Changes are made to the health insurance marketplace regulations nearly every year and keeping up with them can take up valuable time.
Whether you are new to the Health Insurance Marketplace or need an update on current regulations and changes, this guide is designed to provide you with everything you need to know.
Health Insurance Marketplace Regulations Overview
Some of the most important health insurance marketplace regulations include:
- Enrollment periods: There are three effective periods during which you can enroll for health insurance through the marketplace: the open enrollment period, special enrollment periods, or when applying for Medicaid/CHIP coverage.
- Premium tax credits: To help offset the cost of health insurance, premium tax credits are available for individuals and families who make below a certain amount each year. The tax credits can be applied monthly to help make payments more manageable.
- Minimum essential coverage: Every American is required to carry health insurance that qualifies as “minimum essential coverage.” All marketplace plans, most employer-provided plans, and Medicaid/CHIP coverage are considered minimum essential coverage.
Other regulations include things like income limits for Medicaid/CHIP coverage, what to do if you earn more money during the year than you expected, and ensuring you keep your application information up to date.
There are also regulations that impact what kind of health insurance your employer can offer, as well as how small businesses manage and obtain health insurance coverage for their employees.
Changes to the Health Insurance Marketplace Regulations
1. Penalty and Insurance Requirement Changes
One of the health insurance marketplace regulations is that every American is supposed to carry health insurance that meets the standards of minimum essential coverage. While this regulation is still in effect, as of the 2019 plan year, there is no longer a financial penalty for not carrying health insurance.
It’s important to note, though, that there are still state insurance requirements in some places. States like New Jersey and Massachusetts already impose a penalty on people who don’t carry insurance, and starting in 2020, Rhode Island and Vermont also planned to impose fines.
Keep in mind that – even though there is no federally-mandated penalty – you will be responsible for any healthcare expenses you incur if you choose to forgo health insurance.
2. Plan Category and Cost Changes
The health insurance marketplace offers a wide selection of plans with a combination of deductibles, premiums, copays/coinsurance, and out-of-pocket maximums. There are four categories of plans to choose from: bronze, silver, gold, and platinum.
The plans do not impact the quality of care you receive. They do, however, impact how much you have to pay out-of-pocket for your healthcare expenses each year. Higher category plans (gold and platinum) will cover more than the lower category plans (silver and bronze.)
While there are no specific changes to the categories, costs are expected to increase for states like Delaware and Vermont. Other states – like New Mexico and Arizona – may see a decrease in costs.
3. Income Limit and Premium Tax Credit Changes
Every American is eligible to apply for health insurance through the marketplace. There are no health insurance marketplace regulations that prevent people from obtaining health insurance. However, if you want to qualify for premium tax credits, there are regulations in place for those.
Premium tax credits are based on your income and household size. The income limits are determined based on the federal poverty level. Because of this, the income limits for premium tax credits will vary slightly each year.
A single person that makes less than $51,040 each year may qualify for premium tax credits, where a family of six may qualify for premium tax credits if their household income is less than $140,640.
How These Health Insurance Marketplace Regulations Impact You
Depending on your income, household, and health situation, these changes may have a significant impact on you and your health care.
Here’s what you need to do to prepare for 2021:
- Update your marketplace application: Make sure you account for any changes to your income or household size. This may change the premium tax credits you receive.
- Reevaluate your annual healthcare needs: Take a look at how frequently you visited the doctor last year and plan ahead for the next. This can help you choose the most cost-effective insurance plan.
- Figure out your healthcare budget: Just because you don’t have to pay a penalty doesn’t mean you don’t have any healthcare expenses. Consider everything from annual checkups to prescriptions, plus budget for medical emergencies.
The most significant thing most families will need to watch for is how the federal poverty limit will impact their premium tax credits. Families that are right on the cusp of eligibility will need to monitor changes to the income limits very closely each year.
Future Health Insurance Marketplace Regulations
It’s uncertain what changes will come in the future for the Affordable Care Act and the health insurance marketplace. The program is highly controversial and a source of constant debate. However, the most important thing each family will need to watch for is changes to income limits.
Fortunately, keeping track of changes to health insurance marketplace regulations isn’t something you have to do alone. A Fiorella Insurance agent or broker can help navigate the murky world of insurance laws.