ACA open enrollment: Here’s what you need to know

This Saturday marks the start of Affordable Care Act’s second-ever enrollment period. And like last year, the law is looking embattled. Newly empowered Republicans have vowed to chip away at it. The Supreme Court has agreed to review a case that could destroy it. And the impolitic comments of one of the law’s self-proclaimed architects, Jonathan Gruber, has set the conservative opposition alight for the past week.

But health exchange supporters hope all that doesn’t matter this weekend, when the three-month enrollment period begins for people who are uninsured and need to sign up – and for people who already have insurance but need to review their options again.

With that in mind, here’s what to watch for in the Affordable Care Act’s second enrollment season.

Who can enroll?

If you’re uninsured, bought an ACA marketplace plan last year or bought your own coverage outside the marketplace, you can sign up starting Saturday. People earning between 138 percent of the federal poverty level and 400 percent FPL ($16,105 and $46,680, respectively, for an individual) can qualify for financial assistance to purchase coverage. And the lower the income, the greater the subsidy.

If you earn below 250 percent of the federal poverty line, you can also qualify for help with out-of-pocket costs as long as you purchase a “silver” plan on the marketplace. The silver plans, which cover 70 percent of a person’s health-care costs, were the most popular plans sold on the marketplaces last year.

In the 23 states that haven’t expanded Medicaid to all low-income adults, people earning above the federal poverty line ($11,670 for an individual) may also receive subsidies to purchase insurance on the ACA marketplaces. About 4 million people in those states fall in what’s known as the coverage gap – they earn too much to qualify for Medicaid, but don’t earn enough to qualify for subsidies to purchase health insurance.

Is the Web site going to work this time?

Great question! We'll find out Saturday. In all seriousness, though, the Department of Health and Human Services is promising a better enrollment experience on HealthCare.gov time around, though they’ve said it won’t be perfect. One reason to be hopeful it will be better this time: HHS says full testing of the Web site has been taking place for the past five weeks, much longer than the 10 days of testing ahead of the site’s launch last fall. And about 70 percent of users will be able to use a much shorter application this time, compared with last year.

Then there have been some changes in the handful of states that had broken Web sites last year. Oregon and Nevada have ditched their enrollment systems and will use the HealthCare.gov platform this year, while Maryland will use Connecticut’s enrollment portal. Meanwhile, Idaho is the only state that’s newly launching its own system this year.

How long do I have to enroll?

The enrollment period is much shorter this time – it’s only three months, lasting from Nov. 15 to Feb. 15, compared with six months the last round. There’s another deadline consumers should be aware of, though. You must sign up by Dec. 15 if you want new coverage starting Jan. 1.

How do I enroll?

If you live in states with a federal-run marketplace, you can sign up at HealthCare.gov or contact the federal call center at 1-800-318-2596. The state-run exchanges have their own enrollment Web sites and call centers. You can also find in-person enrollment help by searching localhelp.healthcare.gov. Not sure about which Web site your state uses? The National Academy for State Health Policy has a helpful list, and a map from the Kaiser Family Foundation tells you what kind of marketplace your state has.

Can I check out health plans now?

If you’re especially curious, you can start window shopping on HealthCare.gov before Saturday if you’re in a state with a federal exchange. Some other states, like Maryland, have opened their Web sites for browsing. You just can’t buy anything until Saturday, though.

What is this going to cost me?

For what it’s worth, premiums on average don’t appear to be rising as much as expected this year. That’s just on average, though, and the actual cost depends on where you live and whether you can get a subsidy to buy coverage. The cost of the monthly premium is obviously important, but you should also make sure to check a plan’s cost-sharing requirements, like the deductible and copays. These are especially important if you expect to use a lot of health-care services this year. The ACA’s annual cap on out-of-pocket expenses is also up slightly in 2015 – insurers can’t charge more than $6,600 for individual coverage or $13,200 for a family plan.

I signed up last year – do I have to do it all over again?

You could do nothing and automatically re-enroll in your plan, but the Obama administration and consumer advocates are encouraging people to come back and shop again for a few reasons. For starters, if you had changing life circumstances – like having a baby or a change in income – that will affect your subsidy eligibility.

There are more plan options this year, so you could find a better deal. Also, because of the way the subsidies are structured, even if the cost of your plan doesn’t go up, your subsidy may not go as far this year. That’s all to say that you should probably take another look at your options.

I heard the Supreme Court could get rid of Affordable Care subsidies

Just last week, the Supreme Court accepted a lawsuit challenging the legality of subsidies in the 30-plus states where the federal government is running the health insurance marketplace. If the court rules against the administration, that would prevent people in those states from receiving subsidies meant to make health insurance more affordable. People who had been receiving the subsidies wouldn’t have to pay anything back, but it could significantly increase how much they'll have to pay for coverage.

What if I miss open enrollment?

If you miss open enrollment, you’re not entirely out of luck. If you experience certain qualifying life events, like losing your existing coverage or having a baby, you can qualify for a special enrollment period allowing you to sign up. Meanwhile, enrollment in Medicaid and the Children’s Health Insurance Program is open year-round.

What’s the penalty for not enrolling?

The penalty gets a little steeper in 2015. People who don’t have health insurance will have to pay $325 or 2 percent of taxable household income – whichever is higher. People won’t face the penalty for the so-called individual mandate, however, if they earn too little or qualify for an exemption because of certain hardships, like recent bankruptcy or eviction. Just a small portion of the uninsured is expected the pay the penalty for not having coverage, though.

What if I own a small business?

There’s an ACA marketplace for that, too. Small businesses with fewer than 50 employees may purchase coverage through what’s known as the Small Business Health Options Program, or SHOP. The SHOP marketplaces were open last year, too, but the federal Web site didn’t actually launch until last month for select states. So it’s no surprise that SHOP enrollment has fallen well below expectations so far.

There are some advantages to going through the SHOP. The program offers a limited tax credit and it allows employees in most states – but not all – greater flexibility to pick their own health plan.

Who’s still uninsured?

After an estimated 10.3 million people gained coverage in Obamacare’s first year, there are about 32 million people still lacking coverage, according to HHS. Many have remained uninsured because of affordability concerns, though most of the uninsured (55 percent) say they’re planning to get coverage, according to a Thursday Gallup poll.

Who’s going to sign up this time?

There are 7.1 million people currently enrolled in marketplace health plans across the country. HHS is projecting that 9.1 million people will be covered by the marketplaces by next year, after losing about 15-20 percent of current enrollees and gaining some new ones. The department expects about 75 percent of the marketplaces’ new enrollees this year will be previously uninsured. The administration’s projection, released earlier this week, is much lower than the 13 million originally predicted by the Congressional Budget Office.

And don’t forget about Medicaid and the Children’s Health Insurance Program. Those programs have grown 8.7 million people in the past year, and enrollment is open all year for those programs.

This story was originally published November 14, 2014 at 1:41 PM.