Open enrollment for 2018 individual health plans through the Affordable Care Act is upon us. In case you haven’t heard, this year’s process will be a bit different — starting with the fact that national enrollment ends several weeks earlier than before.
Here’s what to know if you need coverage through the ACA, also referred to as Obamacare.
Quick facts on health insurance and open enrollment
- This is the only time to choose or change your health insurance plan for next year, unless you have a qualifying life event that allows you to change coverage mid-year.
- The national open enrollment is Nov. 1 through Dec. 15 — half as long as last year — for anybody who buys an individual health plan through the federal marketplace, through a broker or directly from an insurer. If your state has its own marketplace, you may have more time.
- Health insurance is still required by law, the Affordable Care Act’s individual mandate. If you go without, you could face a tax penalty. For 2017, penalties are $695 per adult and $347.50 per child, or 2.5 percent of annual household income over the federal filing threshold — whichever is greater. The penalty is scheduled to rise with inflation, but the exact amounts for 2018 haven’t been announced yet.
- Only people who buy through healthcare.gov or a state exchange can receive tax subsidies to lower costs. However, you can shop and compare plans in a variety of ways: in person with a navigator or broker, or on other websites that make comparing easy.
- For those who get health insurance elsewhere, your open enrollment period (if any) is likely different. The vast majority of Americans (82 percent in 2016) get health insurance from an employer, Medicare or Medicaid, according to the Kaiser Family Foundation.
About those tax subsidies…
Cost-sharing subsidies are government payments to insurers that reduce out-of-pocket costs for lower-income Americans with certain ACA plans. Federal funding for these subsidies was recently cut, and without them insurers have said they’ll raise premiums.
But insurers are still required to provide reduced cost sharing to lower-income families. That means consumers who qualify for subsidies will still receive them — in 2018, at least.
Don’t skip open enrollment altogether
If you have an ACA plan already and skip open enrollment:
- If your plan is available next year, you’ll be re-enrolled in it automatically.
- If your plan is discontinued for 2018, you’ll be automatically enrolled in another plan.
Because health plan options and prices change each year, the plan you have now may no longer be the cheapest or best for you — especially in this year of uncertainty. If you’re auto-enrolled in a different plan, your doctors and drugs may not be covered in the same way (or at all), and the price will likely be different.
“To make the best choice, set aside some time to actively shop for your health insurance plan,” says Michael Levin, CEO and co-founder of Vericred, a health care data services company. “Doing so can save money and help [you] make a better selection.”
Two ways to get some help
Federal funding for Affordable Care Act navigators, who help consumers choose plans, has been cut, so there will be fewer of these navigators available in many states this year. That doesn’t mean you’re out of luck; many states fund their own navigators and will see no reductions.
But navigators are only able to provide information already on exchange websites, says Susan Combs, CEO of Combs & Company and an insurance broker licensed to sell ACA plans.
“Brokers, unlike navigators, are licensed insurance professionals and are able to provide opinions and advice about carriers and plans,” Combs says. You can use Healthcare.gov’s help page to find brokers or navigators near you.
Tips for shopping
The most important thing your plan should do is cover your doctors and medications, as well as services you use regularly. To ensure that’s the case:
- Make sure you know your plan’s copayments, coinsurance, and deductibles.
- Check in the summary of benefits or by phone with the insurer that your doctors are in the plan’s network.
- Confirm with the insurer on the phone or in the plan’s summary of benefits that it covers typical services and treatments you use.
To make shopping easier, Levin advises the following:
- Search online for a health insurance comparison site. A good one can show whether your doctors participate in each plan and whether your drugs are covered.
- Note whether deductibles apply before insurance pays for services you use. Two plans may look similar, but in one case there may be no deductible to see your primary care physician, while in another it could cost you.
- Don’t assume you’re not eligible for a subsidy; check Healthcare.gov or your state exchange to be sure.