Don’t procrastinate. Most consumers who buy their own insurance on the federal health insurance marketplace face a Dec. 15 deadline. Advocates are reminding these customers that if they miss the deadline, they may not have a plan that starts in January 2019.
Despite repeated efforts by Republicans to repeal the Affordable Care Act, it remains the law of the land, and subsidies that help bring down premiums and reduce cost sharing are still available to help people afford plans sold on the marketplaces, also called exchanges. Those plans still must provide comprehensive benefits and limit out-of-pocket costs for consumers. If you buy an exchange plan, insurers can’t turn you down or charge you more if you have a pre-existing medical condition.
But Republicans did push through a major change in the law that takes effect in 2019: Consumers will no longer owe a fine if they don’t have health insurance. It’s not yet clear if that has tamped down interest, but data released by federal officials showed that the number of people who had signed up during the first two weeks of open enrollment was down by about 20 percent from a year ago.
If you’re shopping for coverage off the exchange, you’ll probably encounter ads for short-term policies, which the Trump administration is promoting and for which it has loosened the requirements. Those plans generally have lower premiums, but they are riskier buys if you get sick, advocates say. More on those plans later.
If you want to enroll in a marketplace plan, now’s the time to get cracking. Enrollment, which began Nov. 1, will close on Dec. 15 in about two-thirds of states, which use the federal exchange, including Kentucky.
Although you may have more plans to choose from for 2019, there will likely be fewer enrollment professionals on hand to help you pick the one that’s right for you. Here are some tips that may help.
Review all your plan options
If you’re already enrolled in a marketplace plan and don’t take steps to sign up during open enrollment, chances are the marketplace will automatically re-enroll you in your current plan or another one that is similar for 2019. Don’t let that happen.
Even if you like the coverage you have, it’s critical to study the details. Your plan may have essentially the same name, but there’s no guarantee that the premium, deductible and other specifics — like the list of approved hospitals and doctors — will be the same. Check to make sure it still meets your needs.
Many people will have more insurers to choose from for next year. Fifty-eight percent of enrollees will have a choice of at least three insurers in 2019, compared with 48 percent who did so this year, according to an analysis by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.) Meanwhile, the share of enrollees with just one marketplace insurer in their area will drop to 17 percent in 2019 from 26 percent this year.
Premiums will edge down slightly for many people next year. The changes vary widely by region, but the monthly unsubsidized premium for the second-lowest-priced silver plan, called the benchmark plan because its cost is used to set the level of federal premium support, will drop by an average 1.5 percent in states that use healthcare.gov, according to the Centers for Medicare & Medicaid Services. For a 27-year-old nonsmoker, that will mean a $6 difference ($412 dropping to $406).
(Silver plans are the most popular type of marketplace plan, picking up 70 percent of the cost of covered benefits, on average. Bronze plans are less generous, paying for 60 percent, while gold plans, at 80 percent, pay a greater share of the costs.)
Keep the benchmark plan in sight
Premium tax credits are available for people with incomes between 100 and 400 percent of the federal poverty level ($12,140 to $48,560 for one person, or $25,100 to $100,400 for a family of four). With more insurers competing for your business and premiums heading down in some areas, the benchmark plan may change in 2019.
If you have the benchmark plan or another one with an even cheaper premium this year, be sure to check out the benchmark plan for next year.
“If you don’t stay with [the] benchmark plan, you could get sticker shock on your premium next year,” said Sabrina Corlette, research professor at Georgetown University’s Center on Health Insurance Reforms.
That’s because your subsidy will be reduced in line with the lower benchmark plan premium, and you’ll have to cover the difference if you don’t switch plans.
Estimate your income carefully
If you’re ineligible for premium tax credits because your 2018 income is too high but you think it may dip below the 400 percent poverty threshold next year, it’s a good idea to sign up for a marketplace plan rather than buy a plan outside the exchange, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation.
“People in marketplace plans whose income drops into subsidy territory are eligible for a special enrollment period to sign up for a subsidized plan,” Pollitz said. “If you’re enrolled in a plan off the exchange, you won’t have that option.”
About 80 percent of people who enroll in marketplace plans qualify for premium tax credits.
To avoid giving people more in advance premium tax credits than they’re eligible for, the marketplace typically asks for additional documentation to verify income when people project that their earnings will be lower than government data sources show.
This sign-up season, the marketplaces are asking for more information from people on the other end of the income spectrum. People with incomes below 100 percent of the federal poverty level aren’t eligible for subsidies. (Lawmakers who wrote the ACA expected these low-income people to qualify for Medicaid, but some states have not expanded their programs under the health law.)
For 2019 coverage, customers who estimate their income will reach or exceed that 100 percent mark, which would qualify them for premium tax credits, will generally be asked to provide additional income information if the marketplace’s data show that their income is below that standard.
The change is supposed to help avoid fraud, but inaccurate estimates may not be intentional, said Tara Straw, senior policy analyst at the Center on Budget and Policy Priorities.
“People in that income range who are often cobbling together income from part-time jobs may not have a great estimation of what their income may be for the coming year,” she said.
Update the marketplace with your personal and plan information
Make sure to update your income and family information in your marketplace account. Otherwise, the marketplace may make an error in calculating the amount of your premium contribution, and you could be on the hook to repay excess subsidies at the end of the year.
If, while shopping for a plan, you get a notice that you’ve been automatically re-enrolled, don’t assume the marketplace will cancel that plan when you sign up for something else. Tell the marketplace that you want to terminate that plan, or you may end up owing a month’s premium for both plans while you get it sorted out, said Straw.
Complicated coverage questions? Get help now
This year, the federal government cut funding for navigators — those groups and individuals helping people sign up for coverage on the marketplaces — to $10 million, continuing a steady whittling away of support for that program from more than $60 million two years ago.
“My advice is, ‘Don’t procrastinate,’ because there is less one-on-one help available in most states,” said Corlette.
If you live in a state that runs its own marketplace, you may have an easier time finding in-person help with coverage questions. Those exchanges are generally spending significantly more on outreach and assistance than the federally facilitated exchange, according to an analysis by researchers at Georgetown University and published by the Commonwealth Fund.
Approach short-term plans with extreme caution
To make more affordable health insurance options available, the Trump administration issued a rule in August that eases restrictions on short-term plans that are less comprehensive than ACA-compliant plans. These plans generally don’t cover pre-existing conditions nor benefits like maternity care or prescription drugs. They can be renewed for up to three years, but that will be at the insurer’s discretion.
Because they offer much skimpier coverage than comprehensive plans that comply with the health law, short-term plans are generally cheaper.
Any plan offered through a state exchange must comply with the ACA. But people shopping online may see noncompliant coverage featured on other sites and find it hard to distinguish ACA-compliant plans from short-term and other types of limited coverage, such as health care-sharing ministries and fixed-indemnity plans, said Corlette, who has examined these offerings.
“It’s a mishmash of stuff that falls outside of the ACA,” Corlette said.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.