2018 Individual Marketplace Guidance
Health and Human Services had released earlier this year the final version of its 2018 Individual Marketplace Guidance. Under the Affordable Care Act (ACA) this is issued annually. While the guidance is mostly related to the individual marketplace it does, however, include several items relevant to employers and group health plans.
- Annual limits for cost sharing (out-of-pocket limits)
- Marketplace eligibility notifications to employers
- Marketplace annual open enrollment period
- Small Business Health Options (SHOP) Exchange
Nov 2017- 2018 Individual Marketplace Guidance.
Nov 2017 – Emnployer Reporting 2017 Updated 1094 & 1095 Now Available
On Exchange Maximum Household Income for Subsidy
Your decision on which will depend on your Household Income and the number of people in your household applying for coverage. In the chart below, if your HOUSEHOLD income (include all members or your tax household regardless of if they are applying for coverage or not) is below the limit shown based on the number in your household applying for coverage, then it is better for you to apply via your state marketplace such as the NY State of Health.
|# of Household Members Applying for Coverage
|Maximum Household Income for Subsidy
|Each Add’l. Household Member
MEDICAID EXPANSION: For those with incomes less than 200% of the Federal Poverty level you should also enroll via NYSOH as you might qualify for the United Healthcare Essential Plan.
ENROLLING ON NY STATE OF HEALTH
To enroll via NYSOH and have us as your broker use this link for instructions. How to Select a Broker on NYS of Health marketplace.
Alternatively, If you earn too much to qualify for a subsidy we will enroll you OFF EXCHANGE. The application forms can be found using the Oscar link above. Download the FULL ENROLLMENT KIT and complete the necessary forms to send to us for processing.
2018 NY State of Health Open Enrollment Runs from 11/1/17 – 1/31/18. Special enrollment period runs throughout the rest of the year for qualifying events.
ANNUAL LIMITS FOR COST SHARING:
The annual out of pocket limits for plan years beginning on or after January 1, 2018 are $7,350 for individual coverage and $14,700 for family coverage. These cost sharing limits apply to in-network essential health benefits offered under non-grandfathered health plans, both fully and self-insured. Annual deductibles, in-network co-insurance and other types of in-network cost sharing accumulate toward the out-of-pocket limit, including prescription drug copayments. Not included are premium payments, out-of-network cost sharing and spending on non-essential health benefits.
MARKETPLACE ELIGIBILITY NOTIFICATIONS TO EMPLOYERS:
Beginning in 2017, the Marketplace will notify an employer as soon as possible when one of its employee’s first enrolls in subsidized Marketplace coverage. Since some employers may be liable for a penalty under the ACA’s employer mandate when an employee qualifies for a subsidized Marketplace coverage, this change to a more proactive notification process will hopefully provide employers with the opportunity to work with CMS in cases where an improper subsidy has been provided.
MARKETPLACE ANNUAL OPEN ENROLLMENT PERIOD:
Open Enrollment in the Health Insurance Marketplace, Healthcare.gov, for 2018 will take place from November 1, 2017 through January 31, 2018.
SMALL BUSINESS HEALTH OPTIONS (SHOP) EXCHANGE:
Beginning in 2017, small employers electing coverage in the SHOP Exchange will have the option of “vertical choice,” offering plans across all metal levels (platinum, gold, silver and bronze) from one insurer. States who opt out of the vertical choice option will continue to offer employers the choice of selecting health plans that are available at one single metal level of coverage.