What is Open Enrollment?
This is the time for each New Mexican resident to enroll in health coverage for 2019 or review their current coverage to determine to renew existing plan or, to make a change to another plan.
When is Open Enrollment?
Open Enrollment begins November 1 and ends on December 15, 2018 for coverage beginning on January 1, 2019. Missed the deadline? Talk to a local professional about the eligibility of Special Enrollment. Find local help.
Do I really need to sign up? What if congress repeals/replaces the ACA? Will there be a penalty if I don’t sign up?
Yes, the Affordable Care Act is still the law. As of January 1, 2019 you are no longer subject to any tax penalties from the IRS.
Are there still subsidies available?
Good news is YES, subsidies including premium tax credits are still available to those New Mexicans who qualify.
Is it true that rates will increase this year? Will I pay more for the same coverage?
Regulators have approved insurance premium increases requested by the insurance carriers. The average premium increase for 2019 will vary. When the rates increase, so do the subsidies. Consumers should shop a variety of plans to identify what best fits their needs and budget.
What if I don’t sign up during the Open Enrollment period?
If you miss open enrollment and don’t qualify for the special enrollment period, Medicaid, CHIP or employer-based coverage, you may find no other option than to wait until the next open enrollment which is for 2020 coverage.
Will there be any changes to the enrollment process?
No, all of the same resources are available, however those enrolling should be reminded that open enrollment occurs from Nov. 1 through Dec. 15.
What would be my effective date of coverage?
If you enroll any time between November 1 and December 15, 2018 and make your first premium payment by the due date specified by your plan, your new health coverage will begin January 1, 2019.
I enrolled through an insurance broker last year, do I need to use that broker again this year?
You’re not required to use a broker or even the same broker as you did last year. However, a broker does provide value in helping you navigate your options and provide guidance regarding questions you may have about health insurance coverage.
I like my Marketplace plan just the way it is, will it stay the same for 2019?
It depends. Insurers are allowed to make changes to policies each year. Most likely, the premium for your 2018 policy will change in 2019. There may be other changes as well, for example, changes in the deductible, coinsurance, or copays for some services. In some cases, an insurer may stop offering a particular policy and offer you new choices instead. Shortly before Open Enrollment begins, you should receive a notice from your insurance company stating either the discontinuance of your plan or informing you of any premium changes.
If you want to continue the policy, you can renew coverage for another year. If you prefer to shop for other coverage, you can do that during Open Enrollment.
I’m eligible for health benefits at work, but I want to see if I can get a better deal at the Marketplace. Can I do that?
You can always shop for coverage on the Marketplace, assuming you meet other eligibility requirements, but if you have access to job-based coverage, you likely will not qualify for premium tax credits. You may only qualify for premium tax credits if the premium for your employer-sponsored coverage is more than 9.66% of your yearly household adjusted gross income, or if the plan does not meet minimum essential coverage standards.
If I have not filed taxes in a prior year, how will the Marketplace determine my income?
If an applicant did not file taxes in a prior year, income will be verified by the Marketplace through use of electronic wage data. If the information cannot be verified electronically, the applicant may be asked to submit additional documentation within 90 days, such as pay stubs, a work contract or other verification of income.
How do I file an appeal through the Marketplace?
You can request an appeal of any Marketplace decision, including decisions about
- Your eligibility to buy coverage in the Marketplace
- Your eligibility for, or the amount of, premium tax credits or cost sharing reductions
- Your eligibility for an exemption from the penalty for not having health insurance
- Untimely (late) notice from the Marketplace about a decision
To make your appeal, start by reviewing the Marketplace’s decision. You will have received the decision (called a determination notice) online if you initially applied online, or in the mail if you submitted a paper application. So far, in the federal Marketplace, the notice will not provide much detail to explain the reasons for the decision, but it will describe the process you should follow if you want to appeal. To request an appeal in federal Marketplace states, you’ll have to submit the appeal in writing. You can write a letter or use appeal forms available on https://www.healthcare.gov/downloads/marketplace-appeal-request-form-a.pdf
. Your written appeal should provide your name and contact information and an explanation of what you are appealing and why.
You can submit documents to the Marketplace that support your case. You can submit documents along with your initial appeal request or at any time during the appeal process, up until a hearing.
The Marketplace may offer you the option of receiving temporary benefits while your appeal is pending. You can accept the temporary benefits or waive them. If you accept temporary benefits during the appeals process and then lose your appeal, you might have to pay back the benefits you weren’t eligible for.
The Marketplace will review your completed appeal once it is submitted. Then the Marketplace will let you know its decision. If you still disagree with the decision, you can request a hearing. While you are waiting for the hearing to take place, the Marketplace may contact you to try to resolve the dispute informally.
For more information on marketplace appeals: https://www.healthcare.gov/marketplace-appeals/