Six Things Health Care Consumers Should Keep in Mind During Open Enrollment
It’s open enrollment again, meaning that it’s time for consumers who don’t have Medicaid, Medicare, employer-based or other coverage to choose private health insurance plans for 2017. An estimated 20 million Americans have obtained health insurance since the Affordable Care Act (ACA) was enacted in 2010 — that’s more than the entire population of New York State! Nationally, the uninsured rate dropped to 8.6 percent in 2016, nearly half of what it was when the ACA was passed into law. And, thanks to the ACA, consumers can be assured that if they lose their job, change jobs or experience another life-changing event, they will still be covered.
Last year, 12.7 million consumers enrolled or re-enrolled in health plans either through HealthCare.gov or a state-based Marketplace. Over 380,000 signed up for coverage through the Marketplace in Illinois. Here are six things for consumers to keep in mind if they are shopping for health insurance this year:
1. Open enrollment starts on November 1 and ends on January 31, 2017.
In order to get a plan that begins on January 1st, however, you will have to sign up by December 15, 2016. If you are applying for coverage for the first time, here’s a helpful checklist of what information (such as tax, income, and address) you will need to complete your application.
If you are renewing coverage and don’t actively pick a plan by December 15, 2016, you will be placed in the same plan as last year or, if that plan is no longer available, HealthCare.Gov will suggest an “alternate” plan for you. It’s better to actively choose a plan because networks and drug formularies may have changed.
2. Consumers will be able to choose among plans with different combinations of premiums, out-of-pocket costs, networks, and other features.
All consumers will have a choice of plans, and all plans on the Marketplace are “Qualified Health Plans” that cover doctor visits, hospital stays, prescriptions, preventive care, and more. Importantly, these plans also cover preexisting conditions. Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health. On average, consumers will have 30 plans to choose from, including 14 silver plans and 10 bronze plans (the most popular levels selected by 9 out of 10 Marketplace enrollees).
This year, the five insurance carriers on the Illinois Marketplace are offering, on average, 29 plans per county (although a handful of counties have only one carrier offering plans). Four insurance carriers from last year remain (Blue Cross Blue Shield, Humana, Ambetter by Celtic, and Health Alliance), and one new carrier has been added (Cigna). Because there are different carriers available in each county and zip code, as well as new carriers to choose from, it’s important for consumers to log on to the HealthCare.gov window shopping tool to see what plans are available in their area.
3. Financial help is available.
Last year, millions of Americans got financial help to lower the cost of health insurance, and you could too. A single person earning $47,520 or less, or a family of four earning $97,200 or less can qualify for a tax credit to reduce the cost of their monthly premium. Also, individuals earning $29,700 or less can get additional help with out-of-pocket costs.
The majority of Illinois Marketplace enrollees (over 75%) received tax credits in 2016. This year, because of tax credits, over 50% of Illinoisans will be able to find a plan in the Marketplace for $75 a month or less. The Department of Health and Human Services estimates that 130,000 Illinoisans who are currently paying full-price for off-Marketplace coverage could be eligible for financial assistance if they shop on the Marketplace this year. It’s worth it to shop around and look on the Marketplace to see if you qualify for financial help, especially if your income is near the threshold for tax credit eligibility.
4. But wait a minute, aren’t premiums going up?
Premiums in many states, including Illinois, have increased this year. This is true for a host of reasons including insurers underpricing plans in the first few years of the ACA, the phase-out of premium stabilization programs this year, and the phase-in of the individual responsibility requirement (i.e., “the mandate”). However, it’s critical to remember that the ACA has built in protections for most consumers in the Marketplace to offset the rate increases: if premiums go up, tax credits also go up.
For example, a 27-year-old in Chicago with an income of $25,000 would have paid $143/month for a benchmark silver plan in 2016. In 2017, that same consumer will pay almost the same amount — $142 per month — because tax credits will increase to compensate for increases in premiums. In fact, 95% of currently enrolled Illinois consumers could save an average of $1,132 by shopping for a new plan this enrollment period.
5. In-person help is available.
If you have questions about your health insurance options, trained in-person assisters can help you find a plan that’s right for you. In Illinois, you can find a free, confidential and unbiased enrollment assister by going to the Get Covered Illinois website and clicking the button that says “Make an Appointment,” which will take you to a tool to find an assister near you. Or you can call the Get Covered Illinois HelpDesk at (866) 311–1119 to ask questions and find an enrollment assister in your community. These assisters are trained in both Marketplace and All Kids/Medicaid plans, which can be helpful to low- and middle-income families.
6. There’s a penalty for most people who don’t get insurance.
If you don’t qualify for an exemption and you are uninsured, this year the fine is $695 per person (plus a soon-to-be announced inflation adjustment) or up to 2.5% of your income, whichever is higher. You may qualify for an exemption if insurance available to you is considered unaffordable (more than 8.16% of your household income in 2017), if you experienced a hardship, or if you are ineligible to purchase Marketplace insurance due to your immigration status. But, for the vast majority of people, affordable options are available. An accident or injury can happen any day. When it does, the last thing you should worry about is how to pay for your healthcare or taking on medical debt.
Thanks to the ACA, consumers have the option to purchase quality health plans and have the financial assistance to help pay for them. As open enrollment begins, consumers should be encouraged to shop for an affordable plan on the Marketplace and obtain the health care coverage that they need for themselves and their families.
*****
Editor’s Note: In wake of recent promises by federal lawmakers to dismantle the Affordable Care Act, the Shriver Center is working in partnership with a coalition of organizations in Illinois to collect stories of people who have benefited from the ACA. Have you or has someone you know benefited from the ACA in Illinois? Tell us your story and make your voice heard here.
Despite hostile political rhetoric aimed at the ACA, consumers should continue to sign up for coverage. Enrolling now is more important than ever.
