Last year, Congress and the Trump administration tried several times to repeal and replace the Affordable Care Act with alternative legislation. Those attempts were unsuccessful, but there are some changes for organizations and individuals to be aware of in preparation for 2019’s open enrollment period, which runs from Nov. 1 to Dec. 15 this year.
The Individual Mandate Has Been Repealed
From the beginning, the individual mandate has been one of the most controversial aspects of the ACA. Proponents argue that it helps lower premiums for everyone else buying insurance through the ACA exchanges, while opponents view it as an unnecessary burden on consumers.
But as part of the tax overhaul legislation President Trump signed into law on Dec. 22, 2017, the individual mandate was repealed, meaning that individuals who forego buying insurance for 2019 will no longer face a penalty. However, this only applies to 2019 and beyond. Individuals who did not purchase insurance in 2018 will still be required to pay the penalty when they file their taxes next year.
Cost-Sharing Reduction Payments for Insurers Are Gone but Federal Subsidies for Individuals Remain
In October 2017, President Trump chose to end the cost-sharing reduction payments for insurers that helped reduce copayments and deductibles for low income enrollees. To make up for this, insurers raised the premiums on their silver plans. While this has led to increased costs for some, others have benefitted. Because the premiums for silver plans help determine federal subsidies, these increased costs have been offset for some consumers, while others who didn’t previously qualify for a subsidy may now qualify for one.
Self Employed Individuals and Small Business May Now Purchase Association Health Plans
In June of this year, the Trump administration moved to allow small businesses and self-employed individuals to purchase group insurance plans known as Association Health Plans (AHPs). AHP insurers offer plans comparable to the types of plans available to larger organizations, but they cost less because those costs are shared.
But as with any kind of major purchase, organizations and individuals should do their homework. While AHP insurers are not allowed to discriminate against individuals with pre-existing conditions, they do not have to cover the 10 essential health benefits that are required for plans in the ACA exchange.
Understand Your Responsibilities Before Open Enrollment Begins
While all of this can be confusing to sort out, the most important thing for employers to remember is this: Until new legislation is enacted, organizations must still comply with all existing ACA regulations. This means companies with 50 or more full-time employees are still required to file 1094-C and 1095-C data correctly and on time or face penalties up to a maximum of $1.5 million.
For more information about the ACA, or to sign up for individual coverage during open enrollment, visit www.healthcare.gov.