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  • Writer's pictureKaren McPhail, RN, MSN

Insurance Changes in the New Year!

Healthcare changes and reform have been a huge focus throughout 2018! The Affordable Care Act (ACA), repeal and replace, and Trump care have been constant topics for discussion and debate.

So what are the real changes that one can expect in terms of health insurance in the new year? What is staying the same in 2019?

Below is a brief review of important areas:

Individual Mandate Penalty:

You will no longer get penalized at tax time if you do not have health insurance in 2019. Lawmakers were successful in repealing the ACA's individual mandate penalty as a part of the 2017 tax bill that was passed.

The penalty repeal takes effect in January 2019.

People who are uninsured in 2019 will no longer face a penalty.

People who were uninsured in 2018 will still owe a penalty (unless they qualify for a specific exemption) when they file their tax returns in early 2019.

Affordable Care Act - ACA:

Although the House did successfully pass the American Health Care Act and there were numerous pieces of the ACA repeal legislation proposed in 2017, no major changes have been enacted for 2019.

Aside from the individual mandate penalty repeal and the subsequent budget resolution's delay of a few of the ACA's taxes, the ACA is still basically in effect.

This includes: Medicaid expansion, employer mandates, pre-existing condition protection, premium subsidies, cost-sharing reductions or cost-sharing subsidies, defined essential health benefits, and medical loss ratio rules.

Premium costs:

The average premium costs increased slightly (< 3%) in 2019. However, the average benchmark premiums, meaning the second-lowest-cost silver plan in each area has decreased.

Open Enrollment:

In most states, open enrollment ran from November 1 to December 15, with all plans becoming effective on January 1, 2019. The same schedule will apply for 2019. If your plan did an extension this year, they may not be extending again for 2019, so check to ensure that you are not late in preparing for 2020!

There are many new insurers that have offered plans in the exchanges in many states for 2019. More enrollment variety for 2019.

Short Term Plans:

In the past, short term health plans were only available for up to three months. Now according to the Centers for Medicare and Medicaid Services (CMS), short term plans can now in 2019 be used for up to 12 months, with the possibility for renewal for up to three years! Short term plans are very limited, but at least now they are more available for those who seek longer gap coverage due to loss of employment, etc. The plans overall have limited coverage, but are less costly.

Policy Changes :

In comparison to prior years, for 2019 there were various options and differences from one plan to another within a given level. Individuals and small businesses hopefully compared policies before choosing and did not simply re-enroll... Always examine options and compare before moving forward!

In 2018, the Trump Administration made changes to the rules that apply to short-term limited duration health plans (STLDI), and to the rules that apply to association health plans (AHPs). These changes made these plans more readily available as a substitute for the regular ACA-compliant individual market health insurance.

This however has a serious down side which is less effective and less comprehensive coverage as everything comes at a cost!! In the world of healthcare you generally get what you pay for. Cheaper prices result in cheaper coverage and less coverage...

Medicare and Medicaid:

Virginia opted to expand Medicaid as of January 2019, making roughly 400,000 people newly eligible for Medicaid in the state!

Medicaid pays for most of the 1.4 million people in nursing homes and covers around 20 percent of all Americans, (many being children and older adults).

Beginning on January 1, 2019, there will be a Medicare Advantage open enrollment period from January 1 to March 31. This will allow those enrolled in a Medicare Advantage program to switch to a different Medicare Advantage plan, or to change to Original Medicare.

So although a lot has been discussed and debated, not too many changes have been made overall for 2019!


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