Good morning —
It is now December 13th.
ACA open enrollment is still ongoing. There is a short term deadline coming up soon. If you want coverage to start on January 1, 2022, you must pick your plan by 11:59PM local time December 15,2021.
Open Enrollment goes goes through January 15th on healthcare.gov. It goes at least that long on the state based marketplaces with the exception of Idaho which shuts off open enrollment on Wednesday. Open enrollment is the time when you can sign up for a health insurance plan for any reason at all. You can choose a new plan if you’re already in the market. If you’re currently uninsured, you can pick an ACA plan without a special reason. But the late December and January period is for insurance that starts on February 1, 2022.
So what are the big things to remember:
- Get on it today — A significant chunk of all enrollment happens on the 15th. There is likely to be a long line for help.
- Know what are your core constraints — what hospitals/doctors do you have to have, what drugs do you take, how much can you afford each month and what is the maximum oh-shit amount you can pay?
- Accept that insurance is confusing and complex
- Accept that your goal is to get good enough instead of perfect where good enough is often, for people without significant medical history, avoiding the really bad and hideous.
If there are questions, leave them in comments, and I’ll be monitoring throughout the day.
rikyrah
How is school going?
AJ
Do I have to give an exhaustive medical history if I was uninsured the last 3-4 years?
WereBear
Thank you, David! Thanks to your stellar explanations, I was able to get all my health care shopping done during the pandemic… I think it was three major shifts which were all a different plan & company (not recommended, people…) but it all worked out better because I did know something of what I was doing :)
Appreciate it.
David Anderson
@AJ: No medical history needed. The ACA is what is known as “guaranteed issued” where the insurer has to sell anyone a policy at a standard “community rated” price. The only variation allowed on pricing is age (older pay more; 64 year olds pay 3x 21 year olds) and smokers (tobacco users can be charged up to 50% more in premium but that varies widely between and within states)
Yarrow
Thanks as always for your clear, informative posts and responsiveness in comments. Really appreciate your help a few weeks ago. Got my friend signed up.
BamaLib
My son just turned 27, and is Cobra’d on my wife’s employer policy for another six months. When the Cobra runs out, will that be an “event” which lets him sign up on the exchanges? If not, will there be another open enrollment before then?
AJ
@David Anderson: Thanks a lot David. Appreciate all your help over the years.
Hope academic and family things are going well.
brendancalling
Although I frequently complain about living in Bernie’s socialist paradise, one of the nice things about VT is that as long as there’s a state of emergency, I can’t be pulled from Medicaid. And Medicaid, my friends, is fucking AWESOME.
David Anderson
@BamaLib: Loss of insurance is a special event that will let him buy insurance on the marketplace. He’ll just have a fairly narrow window to do so.
David Anderson
@brendancalling: Yep — one of the things that will be a big challenge in 2022 is that the public health emergency will eventually end so the maintenance of effort requirements that have increased the federal funding of Medicaid will end. At that points tens of millions of people will have to then start re-proving that they qualify for Medicaid.
gvg
If it runs through JANUARY 15th and it is now December 13th, its a month plus 2 days not just 2 days…Did you mean December 15th?
Ohio Mom
@brendancalling: Ohio Son has Traditional Medicaid because he has a disability, and I agree, it’s the absolute best. By miles, of any insurance coverage anyone in Ohio Family has ever had, and I have now have Traditional Medicare.
We’ve never had an argument about what is covered or been turn down, Son has fabulous doctors, and all his medications are free (even the ones that would otherwise be very expensive). As is everything else (unlike the Medicare some people think should be universal).
Ohio (every state administers Medicaid differently) would like to force Son into a managed care plan. I won last year’s go-round but am not optimistic about the future. I consider this a golden age for
Son’s coverage.
Medicaid for All!!!
brendancalling
@Ohio Mom: the only think Medicaid doesn’t cover in VT is glasses, and I can afford those.
I am very much in support of Medicaid for all.
brendancalling
@David Anderson:
Vermont’s administrators told me that it will qualify as a life event/changed circumstances, so I’ll cross that bridge when I come to it. I already got the services I really needed—hearing aid, specifically. Not a single ACA plan covers hearing, and mine is congenitally bad.
wasdeaconblues
My brother-in-law just got his green card and SSN#. In fact, he just flew in three weeks ago and is staying with us.
Can we get him coverage through healthcare.gov? He’s not yet a citizen, of course.
Any advice for him/us? He’s around 40 years old.
Thanks very much David. I’ve enjoyed your posts over the years (although they’re most often way over my head.)
Gretchen
My son is a currently unemployed waiter. His income has been all over the map when he had one. What does he put when it asks for income?
David Anderson
@Gretchen: He should put in his best good faith estimate of his 2022 income.
If he makes under 100% Federal Poverty Level (~$12,800 for a single individual), if he can make a good faith estimate that gets him over 100% FPL that would be a very good thing to qualify him for subsidies that if his income is low, he would owe nothing back to the IRS.
Make a good faith estimate
David Anderson
@wasdeaconblues: I’m pretty confident that your BIL will qualify for subsidies on the Health Insurance Marketplaces —
https://www.healthcare.gov/immigrants/lawfully-present-immigrants/
Guac
My husband and I have earned a bit too much to qualify for subsidies/tax credits in the past, but with the new subsidy levels this year and crazy-high price increases from BC/BS, we took a spin through healthcare.gov last week. Very happily surprised to get slightly over $2k in tax credits for next year!
Many questions
David, a friend in NY state is on a plan that screwed up badly (this is a huge understatement but far too much to go into here) over the past year and is claiming she owes them almost $500 in premiums not claims. Can she be denied coverage on another plan? Can the IRS come after her for this money? Who can she contact for help…she has exhausted all options with the plan itself. Thank you!
David Anderson
@Many questions: Contact the NY State Health Exchange Assistors (https://nystateofhealth.ny.gov/agent/assistors) ASAP
I am not sure what the answer is and I can be confident that all I know about NY State is that it is functionally weird compared to most of the country in how they implement their public health insurance programs.
Many questions
@David Anderson: Thank you. Even I have noticed that weirdness! And thank you again for all these posts…truly an invaluable resource.
Kayla Rudbek
David, it appears that my radiation treatment got billed to the wrong insurance company and so it’s showing up from the health care providers’ billing system that I owe more than my out-of-pocket max for the year. My husband and I tried calling the providers but I still think that the billing is messed up. Should I go ahead and file a complaint with the Virginia state ombudsman for health insurance?
Ohio Mom
@Kayla Rudbek: If it’s true that we spend 1/3 of our lives asleep, what portion do we spend straightening out health insurance snafus? We’ve all been there.
Gretchen
@David Anderson: what happens if he underestimates? Do they come back later and collect a higher premium? And thanks for your help!
David Anderson
@Kayla Rudbek: yes… file away, CC the complaint to your current insurer and the clinical group so that they all get motivated to fix things.
David Anderson
@Gretchen: Hypothetical numbers here:
If he thinks he is going to make $30,000 but makes $45,000 then he’ll owe some of the extra premium subsidies back as taxes.
Scott
This year I had to help my 24 year old navigate the MarketPlace for the first time. Previously, he was covered under my Tricare insurance. It was fairly easy to register, enter in the info, etc. However, when it came to choosing, he had 162 options (this was Austin, TX). Talk about analysis paralysis.
Don’t know if we chose good enough. Based on his estimated income, he got about $300 in month subsidies. He had no medical conditions or health issues. Really, the only thing we figured he had to worry about is the occasional seasonal illness or a sports injury. So we looked up to see which urgent care centers was covered. Took a gamble that nothing serious would happen that would hit the $8700 deductible because that would be backed up by the Bank of Dad. Ended up with a Bronze plan with $0 monthly cost. We’ll see. Still seems like a crap shoot.
Kayla Rudbek
@David Anderson: and when I signed into the account payment website for the health care providers just now, the amount I have in the system as due is zero! So now I am confused….but I still completed filing my complaint with my itemized statement to put the fear of the ombudsman into the billing system!