Uncertainty over the future of the Affordable Care Act was a challenge for insurers and state regulators as they prepared for the 2018 plan year. Various insurers exited or reduced service areas in the health insurance marketplaces, while others threatened exits or delayed participation decisions. In several states, some or all counties seemed likely to have no insurance plan available for residents seeking marketplace coverage. But as of the start of open enrollment, no states had counties without an insurer for plan year 2018

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Of the 498 rating regions in the United States, 146 had only one insurer selling nongroup coverage through its state marketplace in 2017; 125 had just two insurers. Markets with one insurer include the entire states of Alaska, Alabama, North Carolina, Oklahoma, most of Arizona, and rural areas of several states. Markets with only one or two marketplace insurers tend to be much less populated than areas with more competing insurers.

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Research shows an array of questions shared by in-person assisters, local navigators and certified application counselors to the Assister Help Resource Center (AHRC) from November 2015–January 2016. AHRC fielded nearly 1,400 calls during this period pertaining to complex health insurance application filings; eligibility determinations; and enrollment scenarios.The topics of the calls AHRC fielded were:

  • 40% eligibility for financial assistance,
  • 15% how to project income,
  • 11% account creation issues, and
  • 6% changes in circumstances.

The researchers say that the questions paint a picture of complex eligibility and enrollment processes, and could lend valuable insight in preparation for the fall open enrollment period, beginning November 1.

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