A Quick Primer on the Health Insurance Landscape for 2018

The Affordable Care Act is still U.S. law. On May 4, 2017, House Republicans passed a bill to repeal and replace the ACA, called the American Health Care Act. That bill will become law only if the Senate also approves it. Unless and until that happens, the Affordable Care Act is the law of the land.

1. You May Owe a Tax Penalty Next Year

Until the ACA is repealed, you are legally required to have health insurance. For most people who don’t have insurance in 2017, the penalty will be $695 per adult plus $347.50 per child (with a family maximum of $2,085) or 2.5 percent of annual family income, whichever is greater.

2. Humana Bows Out

Georgia has five insurers participating in the exchange in 2017, and only one of them — Humana — will not return for 2018. In 2018, four insurers will be offering plans in the Georgia exchange: Blue Cross Blue Shield of Georgia (mostly in rural Georgia), Alliant, Kaiser Permanente and Ambetter.

3. 2018 average proposed rate hike: More than 29 percent

If the mandates are removed, plans sold to those who aren’t offered coverage through an employer or a government program would become more expensive. That’s because without the individual mandate, fewer people would buy insurance and those most likely to opt out are younger, healthier customers. With fewer healthy customers offsetting the costs, premiums would rise.

The four insurers have filed the following average rate increases for 2018:

Alliant: 18.6 percent

Ambetter from Peach State Health Plan (a Centene company): 12.4 percent (expanding coverage area from 24 counties in 2017 to 44 counties in 2018)

Anthem Blue Cross Blue Shield of Georgia: 40.6 percent

Kaiser Permanente: 25 percent

4. Open enrollment for the ACA begins on November 1, 2017

ACA insurance plans have five levels of *coverage that offer the same essential benefits, including hospitalizations, prescription drugs, maternity care, and more.

Platinum – covers approximately 90 percent of health care costs

Gold – covers approximately 80 percent of health care costs

Silver – covers approximately 70 percent of health care costs

Bronze – covers approximately 60 percent of health care costs

*Catastrophic plans. In addition to the categories above, if you are under the age of 30, you can purchase a “catastrophic” insurance plan at a lower cost than a bronze plan.

5. You Can Buy Insurance Directly from an Insurance Company or Agent at Any Time

If you miss the ACA open enrollment deadline, you can buy coverage outside the health insurance marketplace — from the many providers that opted out. Your coverage will take effect soon after you pay your first premium, but you won’t qualify for the premium subsidies available through your state’s health insurance exchange.

6. Become a Groupie

Most people do not realize that they are eligible for group insurance-type benefits as individuals simply through professional or other member associations — much like credit unions. For example, one membership-type plan is The Farm Bureau Health Insurance. It’s not only available to farmers, but rather on a community, so you can join as a member and be eligible.

7. Optimize Your Coverage Based on Your Prescription Drugs

While all major medical health insurance plans provide coverage for prescription drugs, the types of drugs are covered can vary significantly from one plan to another. Research how your insurer covers your specific prescriptions to get the most out of your premiums.

8. Five Essential Questions to Ask:

•     What is the premium?
•     What is the deductible?
•     Is there any coverage for out-of-network care?
•     What is the maximum out-of-pocket cost you’ll have to pay?
•     Does the plan fully cover the “essential health benefits” as required by law?

9. Health Insurance Brokers Are the Real MVPs

Navigating the health insurance marketplace is not for the faint of heart. Health insurance brokers, also known as independent licensed agents, can represent multiple insurance carriers at the same time. They know the ins and outs of many different policies, and they can pair the customer with the right plan from the right company. The costs are often offset by the insurance companies — not you.

10. There’s a Discount for That 

•      Ask if you can get a discount for paying in advance if you have a procedure coming up at a future date.

•      Ask if they have a policy where they can allow a discount for paying cash.

•      As technology makes data about the state of our health easily available, many insurers are starting to look at using tools like fitness trackers to minimize risk. As a result, some insurance providers may provide discounts or incentive plans that will save you money, or give you financial advantages.