Your Simple 10-Step Guide To This Open Enrollment Season
If you want to buy health insurance on the Affordable Care Act state exchanges (such as New York) or federally run exchanges (New Jersey, for example), the time to choose a plan for 2018 is here. But you’ll experience a very different, more challenging open enrollment season this fifth time around. Premiums are up – sharply in some cases. At the same time, consumers who qualify for financial assistance – at least 84 percent of everyone on the exchanges – will find comprehensive plans that are more affordable. Funding for enrollment was slashed 40 percent. And plan offerings have changed. It can seem overwhelming.
WNYC's Health team is working with Consumer Reports Senior Editor Donna Rosato to help you find the best plan to fit your health care needs. Just follow these strategies to better ensure that you’re insured.
- Take action! Don’t default to the same plan even if you get insurance through the workplace. If you already have coverage and do nothing, you will be automatically re-enrolled in that plan. DON’T ALLOW THIS TO HAPPEN. Plans, premiums, deductibles, networks of doctors, hospitals and other providers change every year. You need to at least review your plan before you renew it, confirming that the plan you have is still the least expensive, best coverage now. Most people save money when they switch plans during Open Enrollment.
- Know your enrollment dates. For New Jersey and the 38 other exchanges that use the federally run Healthcare.gov, sign up is Nov. 1 to midnight Dec. 15. New York and the eight other state exchanges, including Washington, D.C., extended their sign-up periods, as late as Jan. 31,, 2018. You can find state deadlines here.
ALERT: The federal exchanges will be closed “for maintenance” most Sundays, midnight through 12 noon (EST). That means you can’t compare plans or enroll in one. You can still call and talk to a person at Healthcare.gov. The website will be open Dec. 10, the last Sunday before the enrollment period ends.
- Find out if you can get financial help to pay your monthly premiums. You probably can, since 84 percent of people qualify. Most people can find plans with premiums costing $50 to $100 a month; many can find plans for less than $50 a month. About 80 percent of people buying on the exchanges can find a plan for less than $75 a month, because of the subsidies available to reduce their monthly premiums. That's up from 71 percent for last year's open enrollment.
- See if you qualify for extra savings to reduce out-of-pocket expenses. Don't focus on premiums alone. In addition to financial help that lowers those monthly payments, many people qualify for Cost Savings Reductions (CSRs) that cut their out-of-pocket costs for expenses such as deductibles and co-pays. Qualifying for these depends on your income and on choosing a Silver plan. You can see if you qualify here.
- Understand your options. Depending on the type of plan you choose – Bronze, Silver, Gold or Platinum – you’ll pay a different percentage of total yearly costs for your care; your insurer will pay the rest.
How Plan Types Differ in Costs and Coverage:
Bronze Covers 60 percent of your medical costs. Bronze has the highest out-of-pocket costs (what you pay toward your deductible and for co-pays) and the lowest monthly premiums.
Silver Covers 70 percent of your medical costs. Silver is the only plan that qualifies for financial help to lower your out-of-pocket costs. That’s why if you qualify for Cost Savings Reductions (CSRs), you should buy a Silver plan.
Gold Covers 80 percent of your medical costs.
Platinum Covers 90 percent of your medical costs.
Gold and Platinum plans have the least out-of-pocket costs and the highest monthly premiums. They both offer the most comprehensive coverage.
ALERT: Because insurers raised premiums on Silver plans the most, you may actually be able to pay less for a Gold plan, which has more comprehensive coverage than a Silver plan.
When does Silver now make sense for you? If, given your income, you qualify for subsidies to pay your out-of-pocket costs, you should seriously consider a Silver plan.
Who qualifies for out-of-pocket subsidies covered by CSRs? If you earn $12,000 to $30,000 a year as an individual, or $25,000 to $62,000 as a family of four, you qualify for CSRs. You should buy a Silver plan.
Who qualifies for Premium Tax Subsidies? Financial help to pay your premiums is based on a sliding scale and depends on your household income and the number of people on your insurance plan. Generally, you can qualify for a tax credit if you earn up to $48,000 a year for an individual; up to $98,000 a year for a family of four.
- Estimate your healthcare costs. Determining which plan is best for you means understanding the type of health care consumer you are. No one can predict a medical crisis. But if you have a chronic health condition or regularly take medication, your health care costs will be higher. In general, if you go to the doctor a lot, you’ll want a plan with lower out-of-pocket costs (co-pays and deductibles). The tradeoff is that you will have higher premiums. Try www.fairhealthconsumer.org to estimate your yearly health care needs.
When you log in to HealthCare.gov, you can then choose your expected medical use – low, medium or high – for yourself and for each family member. That will steer you to a plan better suited to your needs.
- Find plans accepted by your doctors that also cover your medications. The insurance plans your doctors accept may change every year. So do the prescription drugs covered by your insurance. Use the Doctor, Hospital and Prescription Drug Lookup tools at healthcare.gov. Search for your doctors, medical facilities and the prescription drugs you take. When you compare plans, you’ll see which cover these in network.
- See if you qualify for Medicaid. There is no open enrollment period for Medicaid. You can sign up any time of the year. But if you use the ACA exchanges during open enrollment and you qualify for Medicaid, you will be automatically enrolled.
- Sign up! You can enroll online, over the phone or in-person. In New Jersey and other states using a federally run exchange, go to HealthCare.gov or CuidadoDeSalud.gov to sign up online. Elsewhere, visit your own state’s health exchange to enroll online. In New York that would be nystateofhealth.ny.gov.
ALERT: You must pay the first month’s premium for your coverage to take effect. Some plans accept that payment through the online application system; others send a bill by mail.
10. Look beyond the exchanges if you don’t qualify for financial help. You might do better shopping off-exchange this year, because some states encouraged insurers to boost premiums only on exchange plans. An off-exchange plan is one that you purchase directly from an insurance company or an insurance broker.
ALERT: Make sure you are getting a plan that is ACA compliant or you will pay a hefty penalty for not having qualifying coverage. So-called short-term coverage, limited-benefit plans and critical illness plans, for example, don’t comply with the ACA.
MONEY SAVING NOTE: Some 5.4 million people bought off-exchange in 2017. But almost half of them could have qualified for subsidies if they had bought through HealthCare.gov or nystateofhealth.ny.gov (or their own state's exchange). So make sure you compare both on- and off-exchange plans. If you think your income will fluctuate or change during the year, buy on-exchange. If you buy off-exchange and your financial situation changes, you won’t be able to get subsidies until you sign up for an on-exchange plan during the next open enrollment period.
If you don’t have insurance ... If you don’t sign up for ACA health insurance and don’t have coverage from another source, you will likely pay a penalty of whichever is greater: $695 for each adult and $347.50 for each child up to $2,085 per family, or 2.5 percent of your household income above the federal tax filing threshold (that’s $10,400 for a single filer, $20,800 for people filing jointly in 2017, whichever is greater. The penalty is waived if you don't qualify for financial help and the cheapest ACA plan available would cost more than 8.05 percent of your household income. Here’s how to know if you have an exception to the penalty.
WHERE TO GET HELP
By Phone: Marketplace call center representatives at Healthcare.gov are available to help 24/7, every day (except Thanksgiving) at 1-800-318-2596. Assistance is available in many languages. The call is free. At nystateofhealth call 1-855-355-5777 (TTY 1-800-662-1220) for help.
In-Person: Need help with your health insurance application? You can enter your ZIP code at the Get Covered America Connector to make an in-person appointment.
Free and confidential local help in your community visit: LocalHelp.HealthCare.gov.
