Open Enrollment (Healthcare Coverage)

The Affordable Care Act (ACA), signed into law in 2010, guarantees every American access to minimum essential healthcare coverage.  The requirement to maintain minimum essential coverage, known as the “individual mandate,” was eliminated by the Tax Cuts and Jobs Act, which became law in December 2017. Therefore, you are no longer required to purchase health insurance during 2018 Open Enrollment for plans beginning in 2019, UNLESS you live in Massachusetts, New Jersey, Vermont, or the District of Columbia, where state law requires you to purchase health insurance. But, no matter where you live, it’s still wise to acquire coverage that best fits the needs of you and your family.

In Hawai‘i, most people are already covered due to the Prepaid Health Care Act, which mandates that all employers with one or more employees, whether full-time or part-time, provide coverage for employees who work at least twenty (20) hours per week. Information on the Hawai‘i Prepaid Health Care Act is available here.

If you live in Hawai‘i and do not have healthcare coverage through Medicaid, Medicare, or your employer, or if you are self-employed and need to buy your own health insurance, you can purchase coverage through the Health Insurance Marketplace online at healthcare.gov. Note that as of 2015, Hawai‘i no longer operates a state-based exchange and instead uses the federal marketplace found on healthcare.gov.

Open Enrollment for 2019 health plans run from November 1, 2018 to December 15, 2018. If you do not purchase coverage by December 15, qualify for a Special Enrollment Period, receive coverage through Medicaid or the Children's Health Insurance Program (CHIP), or Medicare, you will not be able to obtain health insurance for 2019, unless you are auto-enrolled in a plan on the last day of Open Enrollment. Click here for more information. Please note that if you live in the District of Columbia, California, Colorado, Rhode Island, Minnesota, Massachusetts, or New York, your open enrollment dates are different and you should check your state’s rules for obtaining health insurance.

 

The following information applies to the 2019 Open Enrollment Period:

 

2018 Customers

For consumers who purchased health insurance for 2018, your coverage will end on December 31, 2018. If you take no action, you may be automatically re-enrolled in your current plan, or - if it is no longer offered - something similar. Therefore, it’s vital to update your information and check on available plans once open enrollment begins to ensure your coverage will meet your needs for the upcoming year. Click here for more information.

 

There are several important reasons that you should still visit healthcare.gov during Open Enrollment:   

  • Your income and employment information may be out of date. Updating this information will ensure that any financial assistance you receive is calculated accurately. Financial help is based on your expected income for 2019 (not 2018). If you don't update your income and household information, your premium tax credit and other savings could be wrong for 2019.

  • Your insurance company may have made changes to your coverage. Insurers sometimes change things like hospital networks and co-payment rates. Log-in to make sure your plan still meets your needs and your budget.

  • New, affordable plans may be available that better suit your needs. Even if you were satisfied with your 2018 plan, it's still a good idea to review any new options for 2019 coverage on the marketplace.

 

New Customers

If you live in Hawai‘i and do not have health insurance, you may use healthcare.gov to access your health coverage options for 2019 during the Open Enrollment period. Open Enrollment is an opportunity to compare the various health plans available to you and find out if you qualify for financial assistance. Every plan available on healthcare.gov is required to cover certain essential benefits, such as prescription drug coverage, doctor’s visits, hospital stays, primary care, and more.

 

FREQUENTLY ASKED QUESTIONS

 

Am I eligible for healthcare.gov?

To be eligible to enroll in health coverage through the Marketplace, you:       

   

If you have Medicare coverage, you are not eligible to use the Marketplace to buy a health or dental plan. Learn more about Medicare and the Marketplace.

 

What are the important dates for enrolling in 2019 health coverage?       

  • November 1, 2018: Open Enrollment begins.       

  • December 15, 2018: Open Enrollment ends. After December 15, you can still buy a health plan if you qualify for a Special Enrollment Period.   

  • January 1, 2019: Plans that were sold during Open Enrollment start.

   

What Qualifies as Special Enrollment?

Certain life events may qualify you to obtain coverage through a special enrollment period beyond the Dec. 15, 2018 Open Enrollment deadline. If you do not qualify for a special enrollment period, please make sure you have secured a plan by the Open Enrollment deadline.

Special Enrollment periods are available for many reasons, such as loss of coverage, changes in household size, and changes in residence, among others. A detailed list of qualifying changes is available here.

 

What is Auto-Enrollment?

If you have a plan from 2018 and do not update your information, or double-check on your plan status, you may be auto-enrolled in a plan on December 15, 2018, the last day for Open Enrollment. Even if you suspect you will be auto-enrolled, log-in to your account and verify your plan before it becomes too late to make any changes.

For some, auto-enrollment may be an issue, since the Open Enrollment dates are shorter than in previous years. For example, if your plan’s premiums rose in 2018 and you did not double check your plan’s auto-renewal before the December 15, 2018 deadline, you may be stuck with an unaffordable plan for the entire year.

More information on auto-enrollment is available here.

 

Where can I find 2018 plans and prices?

Hawai‘i residents can view 2018 plans and prices here: https://www.healthcare.gov/see-plans/. Once plan previews become available in the weeks leading up to Open Enrollment, you can search available plans.

 

What If I Need to Renew, Change, Update, or Cancel My Plan?

If you had a marketplace plan in 2018, you can make changes during open enrollment. Additional information is available here.

 

If I have trouble with my application, is there anyone to help me?

Live representatives with healthcare.gov are available at 1-800-318-2596.

 

What If I Have a Pre-Existing Condition?

The ACA still guarantees coverage despite any pre-existing health conditions you may have.

 

What if I have health insurance through my job?

The Marketplace is designed for people whose jobs do not provide health care benefits, or individuals who are self-employed and need to buy their own insurance. If you have an employer-sponsored health insurance plan you like, you can keep it. Employer-sponsored plans, also known as “group coverage” satisfy ACA requirements and are considered minimum essential coverage.

 

What if I have Medicare or Medicaid?

If you receive coverage through Medicare or Medicaid, you do not need to apply for health insurance through the Marketplace. If you think you qualify for Medicaid, you can check online.  

 

Where can I get local advice about my health care options?

Authorized navigators can help you enroll in the Marketplace. For a list of authorized navigators, click here.

 

Will I Be Eligible for Premium Tax Credits?

Premium Tax Credits, or “premium subsidies,” still are available in the exchange for individuals and families looking to purchase private health insurance through the marketplace. You can determine if you are eligible for financial assistance online. More information is available here.

Remember that your income may have changed from the previous year, and your ability to qualify for financial assistance may have changed. Also, remember that premium tax credits only are available if you sign up for coverage through the exchange.

 

How Can I Estimate My Savings?

In order to receive subsidies or tax credits, coverage must be purchased on the exchange. A tool that helps you estimate your savings is available here.

 

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