Health insurance can get confusing, especially during the federal Health Insurance Marketplace’s (Healthcare.gov) open enrollment period each year.
Here are some things to know about health care for 2023.
What Is Open Enrollment?
Open enrollment refers to the time period when you can add or change your health insurance. Outside of that time frame, you can only make changes if you have a certain change in circumstance, like getting married or having a baby.
When Is the Marketplace’s Open Enrollment Period?
If you plan to apply for health coverage through the Affordable Care Act (ACA) on Healthcare.gov, you can sign up or change your plan from Nov. 1, 2022, through Dec. 15, 2022 for coverage beginning on Jan. 1, 2023. If you don’t act by Jan.15, 2023, you can’t get coverage for 2023 unless you qualify for a Special Enrollment Period.
There Was a Lot of News a Few Years Ago About Repealing the ACA. Was It Repealed?
No. Two bills to repeal the ACA were introduced to the Senate in 2017, but they did not pass. The ACA is still in effect.
What Changes Have Been Made to the ACA in 2023?
The 2023 open enrollment period will be similar to 2022, with a few changes. You can expect some of the following for 2023:
- There is now an option to sign up for coverage mid-year through a Special Enrollment Period if you have a qualifying life event (loss of other coverage, marriage, divorce, move, etc.).
- A policy that allowed insurance companies to deny renewal on policies for people who had fallen behind on premium payments is now gone. If you fell behind on premium payments or you lost coverage because you couldn’t pay, you can now enroll in a 2023 policy with the same insurance company.
- A glitch in previous years made some families ineligible for marketplace subsides (a benefit that lowers the cost of your insurance) if they had “affordable” job-based coverage. The glitch didn’t calculate the higher costs in premiums for adding family members to a policy. This made some job-based coverage seem more affordable than it was. New 2023 guidelines will remove this glitch.
- People with an annual income of $20,385 for a single person or $34,545 for a family of three will be able to sign up for coverage year-round.
I Live in Georgia and I Just Heard That I Cannot Access Healthcare.gov Anymore. What Happened?
On Nov. 1, 2020, Governor Kemp's plan to remove Healthcare.gov as an enrollment option was approved by federal officials. As of 2023, Georgia residents will no longer be able to enroll for health care coverage through Marketplace. You will still be able to acquire heath care coverage through private brokers and private insurance companies.
Georgia will be the only state that does not have a government-run website to enroll in ACA coverage.
Will I Pay a Penalty If I Don't Buy Health Insurance?
As of 2019, you no longer have to pay a tax penalty if you don’t have health insurance. But you might still be subject to a state tax penalty.
What Are the Essential Terms I Need to Know?
When you review your options for health insurance, there are some terms you need to know so you can make the best decision for you and your family.
Your monthly premium is what you pay each month for the cost of your plan.
There are also costs you pay each time you need care. These are called out-of-pocket costs.
Out-of-pocket pocket costs include:
- Deductibles are what you pay each year before your insurance takes over payment.
- Co-payments are what you pay to see a health care provider. For instance, your co-pay for your primary care doctor might be $15 and your asthma specialist might be $30.
- Coinsurance is the percentage of your bill you must pay.
- Covered services are services your health plan will pay for, such as medical treatments and prescription medicines.
Finally, know which doctors, specialists and other health care providers are in-network or out-of-network.
- In-network means your health plan has an agreement with that provider for your health care. Co-payments and other costs are generally less expensive if you use in-network providers.
- Out-of-network means there is no agreement between the health insurance company and the provider. Your costs will be higher to see a health care provider out of network.
For more insurance definitions, see the glossary of common terms on FAIR Health’s website.
How Does This Affect Me If I, or Someone in My Family, Have Asthma or Allergies?
Under the ACA, the protections for people with pre-existing conditions still exist if they buy a plan from the Marketplace. That means if you have asthma and allergies, you cannot be denied coverage or forced to pay more for coverage because of your condition.
Will My Asthma and Allergy Medicines Be Covered?
As you shop for plans, look for a medicine list called a formulary. This is a list of medicines covered on that plan. Check your preferred plan’s list for medicines you take before you sign up.
Many questions remain about health care coverage in the future. But for now, the ACA is still the same for people seeking coverage. If you are applying for or changing your plan, it is best to start now.
How Can I Get Help If I Have Questions?
HealthCare.gov has free tools, and many communities offer help to make sure you feel confident you’ve picked the right plan for you and your family. If you have questions about signing up or want to talk through your options with a trained professional, you can get free and confidential assistance:
- Online: Information is available at HealthCare.gov and CuidadoDeSalud.gov.
- By phone: Marketplace call center representatives are available to help all day, every day at 1-800-318-2596. TTY users should call 1-855-889-4325. Assistance is available in many languages. The call is free.
- In person: Consumers can find free and confidential local help in their communities by visiting LocalHelp.HealthCare.gov or you can make an appointment with the Get Covered America Connector.
Updated November 2022