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Open Enrollment On Healthcare.gov Ends Dec. 15. Do I Still Have To Buy Health Insurance?

It's health insurance shopping season.

It's open enrollment season for people who buy their health insurance through the Affordable Care Act marketplaces. After a series of repeal efforts and back-and-forth on the so-called Obamacare at the federal level, there's a lot of confusion to sort out.

Health News Florida has pulled together a Q&A to help you navigate your health insurance shopping experience:

Q: Do we still have to buy insurance?

A: There's no longer a penalty for going without insurance. But let's back up here a little.

The Affordable Care Act has both carrots and sticks written into it. The carrots are: if you meet certain income requirements you're eligible for potentially loads of subsidies to help you pay for your health insurance; the insurance can't deny you coverage for pre-existing conditions; and, with health insurance purchased at healthcare.gov, there's a whole list of services and treatments that have to be covered under these plans.

The carrots are still here.

The sticks: in the past, if you didn't buy insurance—along with all of the risks of not having insurance—you would be penalized come tax time. President Donald Trump's administration has ended those penalties. The IRS is not going to fine you if you don't have insurance.

If you do buy insurance through healthcare.gov, what's the deal with the silver, bronze and platinum labels on these insurance plans? It's like an Olympic podium out there.

The labels are really just ways of thinking about how much you're going to pay for your health care.

Again, all the healthcare.gov plans are required to cover a bare minimum of services, no matter what the metal level is.

Platinum plans have higher monthly payments, or "premiums," but they have lower annual deductibles. They might have more doctors or facilities in the networks, too.

The bronze plans have the cheapest monthly payment, but they have higher annual deductibles, typically higher out-of-pocket costs, too. And they also may have more limited networks of doctors.

So with the bronze plan, if you're a young healthy person without chronic illness, you're sort of making a bet that you won't need much financial protection. The risk with a higher deductible plan is if, say you get in a car crash on January 1st, you end up paying more for that hospital stay before the rest of the insurance coverage kicks in.

And then what about the silver plans?

These occupy a special place. Part of what makes them popular is that they are the only health insurance plans that can also offer cost-sharing reductions.

When you start shopping on healthcare.gov, you have to fill out your income information and other details. You learn how much of a tax break you might get for buying health insurance. You can get tax breaks at any metal level. But on top of that, you may be eligible for a break on co-pays and deductibles—but only on the silver plans.

And insurance companies are selling a lot of cheaper plans right now, right?

Yup, with some big caveats.

The Trump administration has encouraged a market for short term plans. In theory, they're kind of like cataclysmic emergency plans. The monthly payments may be way lower, especially compared to unsubsidized marketplace plans. But…

…There's a "but"?

But they don't have to cover everything that healthcare.gov plans do. Like maternity care. Or diabetes care. If you get cancer, later on, cancer care.

If you have a preexisting condition, the short-term plans can discriminate against you by charging you more, excluding coverage for certain conditions, or just refusing to sell to you at all.

So buyer beware.

Is healthcare.gov the only place to get a plan that covers everything regardless of your health status?

It's the only place where every plan you'll see meets the minimum standard, and it's the only place to get federal subsidies to help you pay for it.

A lot of insurance companies do offer Affordable-Care-Act-compliant plans—which means the same minimum standards, a year-long contract—outside of healthcare.gov. Which if you make too much money to get a subsidy, it's worth asking about ACA-compliant plans outside of the marketplace. They may be much cheaper than buying them—again, without subsidy—through healthcare.gov.

If you're eligible for a subsidy, chances are it'll be cheaper through healthcare.gov.

The downside on shopping elsewhere is that you really have to do your homework on what's covered and what's not. Once you leave that marketplace, side-by-side comparisons get really tricky. You can go through a broker, but not every broker works with every insurance company.

Can people who are undocumented get Obamacare plans?

No. If you don't have some kind of legally recognized status, you can't buy insurance on healthcare.gov. However, some insurers will still sell you insurance outside of healthcare.gov. You'd still need to do research and make sure you know what it covers and doesn't cover.

What are the deadlines?

You have until December 15th to buy your insurance through healthcare.gov. Those plans start on January 1st. If you miss the deadline, you can only buy insurance if you have what's known as a "qualifying life event"—marriage, divorce, birth, a move, etc.

And heads up: some of the people who were affected by Hurricane Michael may get extra time to sign up for health insurance. If you lived in an area that meets certain FEMA criteria, you might be eligible for a deadline extension, but you have to call the marketplace hotline—1-800-318-2596—to set that up if you need it.

Public radio. Public health. Public policy.
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