Open enrollment for health insurance sold through the Affordable Care Act’s marketplaces begins today. People have until January 31 to enroll in a health plan, but will need to sign up by December 15 for coverage that begins on January 1. Here are five things for consumers to keep in mind.
1. Don’t be discouraged by the news headlines about big premium increases.
- Last week, the U.S. Department of Health and Human Services (HHS) announced that premiums for health plans sold through the marketplaces in 38 states would rise by an average of 25 percent.
- But most consumers won’t pay much more than they did last year. Eighty-four percent of marketplace enrollees are eligible for premium tax credits, or subsidies, that will absorb most of the increase.
2. You might be eligible for a subsidy this year even if you don’t have one now.
- Are you uninsured? An estimated 9 million uninsured people are eligible for subsidies for marketplace health plans. The Commonwealth Fund found that half of currently uninsured adults aren’t aware that financial assistance is available to help pay for coverage.
- Are you buying coverage on your own? About 2.5 million people are currently buying coverage directly from insurance companies but are eligible for subsidies for plans purchased through the marketplaces. If you are buying coverage on your own, visit HealthCare.gov or your state marketplace website to see if you are eligible for a subsidy.
- Do you have a marketplace plan but no subsidy? If you have a plan you purchased through the marketplace but you weren’t eligible for a subsidy last year, you might be this year. You must pay a fixed amount of your income toward your premium, and if your premium increased, you might now qualify for a subsidy.
3. Look before you assume you won’t have any plans to choose from when you go to the marketplaces.
- HHS also announced last week that while 15 new insurance companies are selling plans in the marketplaces this year, 83 pulled out of markets across the country, for a net loss of 68 insurers.
- But while the number of insurance companies selling plans fell in many states, the remaining companies sell several different health plans. This means that consumers will have an average of 30 health plans to choose from when they shop for health insurance, with an array of premiums and deductible combinations. Marketplace shoppers often have more choices than people in employer plans.
4. Shop around for the best deal.
- If you currently have a subsidy for a marketplace plan, it is important to shop around the marketplace to see what plans are available this year. People who are willing to change plans might even find that their premiums will fall this year. More than 40 percent of returning customers switched plans last year.
- If you don’t qualify for a subsidy and your premium has increased, it still pays to shop around. Last year, despite the fact that premiums offered were estimated to rise by double digits, the increases that people actually paid rose by less than that—people tended not to enroll in the plans with the biggest premium increases.
5. If you get stuck during the enrollment process, ask for help.
- Having an average of 30 plans to choose from is both a blessing and a curse. Health plans come with different combinations of premiums, deductibles, and copayments and it can be very hard to understand what that means for your out-of-pocket costs over the year. Deductibles are complex. Many plans cover services before you hit your deductible, so it is important to read the fine print. Healthcare.gov is offering a set of “Simple Choice” plan options this year, which are aimed in part at making these exclusions more consistent across plans.
- Healthcare.gov has a cost-calculator to help you get a rough sense of your potential costs.
- But if all of this is about as clear as mud, enrollment “navigators” can provide personal assistance to help you understand health plan basics and enroll. People who get personal assistance during the enrollment process are more likely to actually enroll in a plan.