2018 Open Enrollment Period – a hardship for many families who do not to qualify for subsidies

The Open Enrollment Period to enroll in a health insurance plan began November 1st, 2017 through January 31st, 2018 in California. In California, many families who are not eligible for subsidies on Covered California, the premium increase in their health insurance is very steep. To remain on the same health insurance premium families are forced to downgrade their health plans or even switch insurance carriers and networks.

The nationwide Open Enrollment Period is actually being shortened from 3 months to 45 days while Californians are fortunate to keep our 3-month enrollment period in 2018.

For many Americans, their insurance choices are steadily dropping and, in some instances, there is only one insurance carrier throughout a given state. For Southern Californians, Anthem is leaving the individual and family health insurance marketplace in 2018 while Health Net is expanding their PPO and Oscar is expanding its EPO provider network.

We are seeing another dramatic rate hike in 2018 with a statewide weighted average increase of 12.5% or 13.2% for the LA area. With such dramatic 10+% annual rate increases for the last few years, the middle class continues to feel the price pressure. For young middle-class families and individuals just starting out in their careers, checking to see if you qualify for subsidies is especially important. An individual earning under roughly $48,000 or a family of four earning under $98,000 in modified adjusted gross income may qualify for subsidies depending on their income. Independent contractors have the benefit of writing off additional expenses from their income and may want to review line item 37 of their 1040 tax return to review the modified adjusted gross income.

Families who are interested in applying for premium tax credits should note that if they are under 266% of the Federal Poverty Level, their children will automatically be enrolled in Medi-Cal, the state’s Medicaid system. If you are a family that earns under the 266% mark, it is advised that you apply for subsidies for the adult(s) and apply for a health insurance plan off-exchange for your children if you do not want your kids falling into Medi-Cal. Many families would like to choose their own health insurance carrier, doctors, and hospitals so avoiding Medi-Cal for their kids can be a very important subject. Please review the 2018 Federal Poverty Level Chart to see where your family stands.

For individuals that just go to their doctor once a year for their free annual wellness checkups and the occasional office visit, it may be best to go with a bronze plan or a plan compatible with a Health Savings Account or HSA for tax purposes. You can also supplement a health insurance plan with a metal gap plan that covers you in the case of an accident or critical illness and will help cover all or most of the high deductibles and out-of-pocket maximums of the bronze and silver plans. Individuals that expect to get non-preventative diagnostics and operations in the coming year should go with at minimum a silver plan to minimize costs going into the deductible. Gold and platinum metal plans have no drug or medical deductible for in-network services and are recommended for patients who have more major medical needs or are willing to accept a higher premium to pay less of a share of the medical costs. Many individuals who are currently on a PPO plan may want to review their 2018 plan as the out-of-network deductibles are increasing to $5,000 for an individual or $10,000 for a family even for the gold and platinum plans. This makes it especially important to stay in-network. Please review your preferred doctors and make sure they are in-network for 2018. You may be required to find a new provider or accept the high deductibles for coverage to begin out-of-network.

At Solid Health Insurance Services, we specialize in helping individuals and families find the right plan for their medical needs and budget. Please do not hesitate to contact us at (310)-909-6135 or visit our website at www.solidhealthinsurance.com. With all the marketplace changes and uncertainty in regards to the Affordable Care Act, why not take advantage of the free service of having an independent insurance agent to go over your insurance options and find you a plan that best fits your own unique needs?