Newsletter

AFFORDABLE CARE ACT OPEN ENROLLMENT BEGINS NOVEMBER 1

Enrollment for Affordable Care Act plans on healthcare.gov begins November 1 and ends January 15. For those who enroll by December 15, the effective date of coverage will be January 1, 2025. For those who enroll between December 16 and January 15, the effective date will be February 1.

As of January 2025, twenty jurisdictions (CA, CO, CT, DC, GA, ID, KY, MA, MD, ME, MN, NJ, NM, NV, NY, PA, RI, VA, VT, and WA) will operate their own exchanges, whereas all other states (including Florida) utilize healthcare.gov. As a minimum, state exchanges must allow enrollment between the same dates as healthcare.gov utilizes, but the state exchanges can begin earlier and/or start later. If you live in a state with a state exchange, check with your local exchange for the open enrollment dates in your state.

Individuals who are enrolled in 2024 plans should be receiving letters from their carriers advising them of changes to their plan for 2025, as well as their subsidy and net monthly premium after the subsidy is applied. They will be told they can be passively enrolled (i.e., they do not need to do anything further to enroll for a 2025 plan but will be automatically enrolled as of December 15). We advise enrollees NOT to passively enroll for 2025 plans because the numbers utilized in these communications are not based on 2025 projected income. Someone who passively enrolls could be surprised when he or she attempts to reconcile income on their 2025 tax return. Our recommendation is for clients to project their income for 2025 and then ACTIVELY enroll by having us help them prepare their enrollment using either our HealthSherpa EDE (Enhanced Direct Enrollment) enrollment system or enrolling in with a carrier that does not participate on HealthSherpa.

ACA plans will be approved during October, and the November newsletter will contain more detailed information about 2025 ACA plans and procedures. We will be attending an all-day session on October 24 where all ACA carriers operating in South Florida will be making presentations. The November newsletter will be covering much more complete information about 2025 plans and enrollment procedures. 

FAQS FROM THE HEALTH SHERPA CONSUMER CENTER

Click on the following frequently asked questions that have been written for the Health Sherpa Consumer Center. Note: we have updated the percentage used to calculate “affordability” throughout the FAQs to 9.02%, as that is the number that will apply to 2025 enrollments.

Getting Started

What is HealthSherpa?

How much does HealthSherpa cost?

What are Qualifying Life Events?

What is Medicaid?

What is the Children's Health Insurance Program (CHIP)?

What is Medicare?

Emergency Resources

ARPA (American Rescue Plan Act) resource for Consumers

Who is considered part of my household?

How do I estimate my household income if I’m the only one getting insurance?

If I file married separately/head of household, can I get a subsidy?

I got denied Medicaid and do not qualify for a subsidy, what are my options?

Am I eligible for a Marketplace plan if my employer offers insurance?

My employer coverage is too expensive if I add my family, can I get a subsidy? 

What is a subsidy?

What is a deductible?

How does a family deductible work?

What is coinsurance?

What is a copay?

What does Out of Pocket Maximum mean?

Is birth control covered under the Affordable Care Act?

INCREASED CONSUMER PROTECTION FOR 2025

Healthcare.gov has become increasingly concerned about the conduct of dishonest agents and others who have changed consumer information; changed agents of record (AOR); enrolled people in plans or changed them to different plans without their knowledge, and similar items. Here are some protections that have recently been introduced or will be introduced for the 2025 open enrollment period:

1. Consumers must give either recorded telephonic or written consent before an agent can help them with a marketplace application. This consent must contain language about protecting the consumer’s personally identifiable information (PII), and the consumer must attest that he or she has honestly answered the questions in the application.

2.     Agents must sign both a Marketplace Agreement and a Privacy Agreement annually. Both agreements have been revised to provide enhanced consumer protection.

3.     Procedures have been established to make it much more difficult for fraudulent agents to make agent of record changes.

4. Consumers will be required to provide Social Security numbers for all family members. Healthcare.gov has found that many consumers have been enrolled who are not eligible for coverage. Accordingly, healthcare.gov is requiring consumers to provide Social Security numbers. Those who cannot provide these numbers must follow special procedures before their applications can be processed. At the same time, healthcare.gov is making allowances that will permit those without Social Security numbers to be enrolled if they follow special procedures that healthcare.gov has developed (e.g., for “dreamers.”)

5. Until recently Enhanced Direct Enrollment systems like Health Sherpa have contained an “override feature” which permitted agents to write policies without being appointed by the specific carrier. The “override” feature can no longer be used. Agents must now have an appointment with any carrier they write or make referrals to another agent or agency who is appointed by the carrier. 

About Paul Cholak

Paul has over forty years of benefits experience and has been Director of Employee Benefits for large companies, as well as a benefits consultant with major consulting firms. He understands the health and life insurance needs of individuals and families of all ages. He also has considerable experience in selling health and life insurance to employer groups.

He guides you through the steps of getting health and/or life insurance and is available to help you both BEFORE and AFTER you've made your purchase decision.