Starting today, consumers in Maryland and across the country can enroll in health insurance for 2018 through the Affordable Care Act. This year’s open enrollment comes at a time when President Donald Trump and many congressional Republicans are working hard to undermine public confidence in a law they have been unable to repeal and for which they have never offered a viable replacement. President Trump nonetheless continues to insist that the ACA is in some sort of death spiral, but the situation isn’t nearly so dire as the law’s naysayers claim. If you don’t get your health insurance through your employer or Medicare, here are the answers to some of the key questions you’ll face.

Aren't Obamacare premiums going through the roof? I can’t possibly afford it, can I?

Yes, the sticker price for the most popular policies on the ACA marketplaces in most parts of the country, including Maryland, were already set to increase by hefty, often double-digit, percentages, and then President Trump made matters worse by announcing that he would stop making certain payments to insurers that are required by the law but for which the Republican Congress has not specifically authorized funding. Late last month, the Maryland Insurance Administration approved additional rate increases for both carriers that offer policies on the state exchange, bringing the total premium hike for CareFirst BlueCross BlueShield’s HMO to 58.2 percent over last year. The rate for the insurer’s PPO will be 76 percent higher. Kaiser Permanente’s rates will go up 43.1 percent.

But there are some big asterisks here. First, those rate increases only apply to “silver” level plans, which are the mid-tier option on the exchange. And second, another component of the ACA increases the level of subsidy support low- and moderate-income individuals and families receive based on the cost of silver plans. That’s why insurance regulators here and in many states increased the cost of silver plans but not others after President Trump’s announcement. The rates went up, but so will the subsidies that the vast majority of enrollees on Maryland’s insurance exchange receive. In fact, the Kaiser Family Foundation reported this week that many low-income people will now qualify for no-cost bronze plans as an ironic result of the president’s action. (The cost to the federal government will go up, too.)

How can I figure out what’s the best deal for me?

When President Barack Obama was first pitching the ACA nearly a decade ago, he promised a system in which buying health insurance would be as simple as ordering a book on Amazon. But health insurance offers a lot more choices than paperback or hard cover. Individuals and families need to evaluate their health needs and financial resources. Do you have chronic conditions that require frequent visits to the doctor, or are you just trying to protect yourself from the chance of an unexpected but catastrophic health event? Are there particular medications you need? Can you afford a plan with higher out-of-pocket costs for deductibles and co-pays that offers a lower monthly rate? Which of the plans on the exchange does your doctor participate in?

That can get complicated, but there are plenty of ways to get help. ACA navigators offer free, expert assistance in finding the right plan and ensuring you get the subsidies you’re entitled to. They can determine whether you’re eligible for Medicaid, too. For information on how to connect with one, go to, or call 855-642-8572. Information is also available there about how to work with an authorized insurance broker, a local or state health department or other entity to get help.

Most Marylanders do qualify for some sort of assistance.

Health insurance navigator Joshua Morris

But isn’t a total mess?

It was when it first launched four years ago. Lots of states had problems with their ACA websites initially, and Maryland’s was arguably one of the worst. State officials scrapped it altogether and started over. Not only does the website now work, but the exchange also has a mobile app that has been downloaded 180,000 times.

Do I really need to bother with this?

Legally, yes. Although the Trump administration has criticized the requirement that virtually all individuals have health insurance, it remains the law, and those who don’t have a qualifying policy are subject to fines of 2.5 percent of household income or a flat fee of up to $2,085 ($695 per adult and $347.50 per child), whichever is higher.

As a practical matter, yes. Going without health insurance puts you and your family at tremendous risk. Even with the reforms of the Affordable Care Act, medical bills remain the No. 1 cause of bankruptcy.

Health is everything, so take care of yourself by getting health insurance now.

Baltimore City Health Commissioner Dr. Leana Wen

And morally, yes. The principle of insurance is to spread risk. The more people who are in the system, the better it works. If you opt out of the system, you raise the costs for everyone else. The ACA was able to extend key protections to sicker patients, like a ban on refusing insurance to those with pre-existing conditions and the elimination on lifetime caps on benefits, based on the promise that the individual mandate would broaden the risk pool. If that doesn’t happen, those key reforms may not survive until the point when today’s younger, healthier people eventually, inevitably, need them.

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