Many current and future clients are still not aware of what the laws are surrounding the ACA with regard to their individual health insurance plans. It’s going on year nine now, after all, so let’s do a quick rundown.
Essential Health Benefits: As it currently stands, in order for a plan to be “ACA compliant”, it must contain the 10 essential health benefits. Some of the more popular provisions include emergency care, mental health benefits (which you’ll need when you see the premiums this coming year), prescription drugs and preventive care. You were probably thinking that all plans covered this stuff anyway, but that wasn’t always the case. Before the passing of the ACA back in 2008, many plans were more stripped down and didn’t offer maternity, preventive care, etc. I know the plans cost more now, but hey, now you can get that free colonoscopy you’ve been waiting on for Christmas this year! Enjoy and happy holidays!
Open Enrollment: This has actually changed since the ACA came into being. For the first 8 years, open enrollment lasted 90 days each year from Nov 1st-Jan 31st, but no longer. Mr. Trump decided to shorten the open enrollment period to only 45 days this year from Nov 1st-Dec 15th, 2017. It’s fairly obvious that this was done in an effort to restrict the number of people signing up for plans to “prove” that the ACA is now less popular than ever. On top of that, the governments’ budget for advertising the ACA to the public has been cut from $90 million down to $10 million. Basically, you won’t hear much about it this year through the traditional advertising channels, but that doesn’t absolve you from complying with the next topic…
Shared Responsibility Penalty: This is the main provision of the law that seems to cause the most confusion with my clients. If you have an ACA compliant plan for plan year 2018, the government will still fine you 2.5% of your household AGI, prorated for the number of months you didn’t have the proper coverage. Now here’s where politics come into play. Trump basically said he was going to instruct the IRS not to enforce this part of the law, but it’s still the law. So what do you do? Buy a plan, that’s what you do.
Have you ever tried explaining to the police that it didn’t matter what the law was, you were told that you didn’t have to comply with it. For example, if Trump said that he wouldn’t instruct the police to arrest people for murder, do you really think you can go around killing people and get around the law? Or what if he said police would not be enforcing traffic laws anymore, even though it’s still law, do you really think you can run every red light on the way to the office? Talk about road rage!
It gets even worse with the IRS. When I was young and far dumber than I am now, I got in an argument with the IRS and it basically came down to me stating that I didn’t owe them an extra $42k because of this and that and this. They said, it’s the law, period. They won.
Bottom line, you still need to purchase an ACA compliant plan no matter what you hear in the rumor mill. Until the law changes, which it hasn’t, they will win.
You can accomplish this through several means, namely, an off-exchange individual health insurance policy, a Marketplace plan or a group insurance policy provided by your employer. Other plans like temporary health insurance, international travel policies or fixed indemnity plans won’t get you out of that IRS penalty.
Once open enrollment rolls around in early November, just call us at 866.270.6209 and we’ll quickly place you on the best plan for your situation.