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As ACA "Window Shopping" Begins, Some at Risk of Losing Subsidies

Mary K. Caffrey
Some consumer-friendly features are still in final testing.
CMS previewed a revamped, more consumer-friendly version of last night, with some features still being ironed out, giving shoppers a week to look over their options before the third season of open enrollment begins under the Affordable Care Act (ACA). Enrollment begins November 1, 2015.

But some who have enjoyed subsidies to keep down the cost of their coverage are at risk of losing them because they did not fill out tax returns, according to published reports.

For the first time, an enrollment question will ask consumers if they filed a tax return to show their income is within the limits that qualify for a subsidy. If the family household failed to do so, they risk losing the subsidy. In the past, households at income levels so low they did not pay taxes did not have to file a return, but the availability of assistance to buy health coverage changes that.

The Internal Revenue Service reported in July that 710,000 households had qualified for subsidies but failed to file returns, and had not asked for extensions. Those who receive subsidies to purchase health coverage are required to file form 8962, which many consumers have complained is complicated to fill out.

Uninsured at Historic Lows

The number of Americans without health coverage is now about 9% of the population, a historic low. Despite this, the changes required to the healthcare market and the mandates on businesses continue to leave the public deeply divided about the ACA, based on the Kaiser tracking poll and other measures.

Opinion on the ACA remains divided by party lines, with more Democrats supporting the changes and more Republicans opposing them. However, most observers do not believe that the provisions of the ACA will be reversed because too many Americans now have health coverage and it would be politically difficult to take away benefits now that people are using them.

Changes in 2016, which serves 38 states, will include a calculator feature to help consumer do a better job of selecting coverage that meets their needs based on their expected healthcare use. This is designed to prevent consumers from simply selecting the cheapest plan without examining all the features that each level offers. However, the calculator still lists the lowest cost option first.

Consumers who have some regular health expenses are encouraged to look at silver plans, which have some cost-sharing subsidies depending on the household income. Those who have a serious or chronic illness may want to consider a higher-level plan.

The government will continue to automatically renew customers who don’t want to make any changes, but they must file a tax return to keep subsidies.

Some features are not ready for prime time. The most sought-after feature is one that will let consumers find out if their doctor is in a given plan. CMS is trying to get that feature ready, but delays in getting some information from health plan may keep it from working by November 1, 2015. A similar feature that tests whether a prescription drug is covered is also going through final testing.

To keep pushing people to sign up, penalties for not getting coverage will rise again in 2016, to $695 or 2.5% of income, whichever is greater. After next year, penalty increases will be indexed to inflation.

Finally, some dates for have changed (again). Open enrollment runs from November 1, 2015, through January 31, 2016. However, to have coverage by January 1, 2016, enrollment must be complete by December 15, 2015.

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