Shop, compare — and beware, when shopping for health insurance outside official government marketplaces.
That’s the message from health experts during the annual plan selection period on state and federal marketplaces for Obamacare health insurance. Despite uncertainty about the future of the Affordable Care Act, people in many parts of the country will find more plan choices and lower premiums.
But this year, there are also options for buying Obamacare plans outside the exchanges. So consumers need to ask questions to make sure they are getting a plan offering robust benefits as required by the Affordable Care Act.
Outside the marketplaces, “it’s the Wild West,” said JoAnn Volk, a research professor with the Center on Health Insurance Reforms at Georgetown University.
Open enrollment on HealthCare.gov, the federal online exchange for people who don’t have health coverage through their job, began Nov. 1 and runs through Dec. 15 in most states, for coverage beginning in 2020. (Some states started earlier and have later deadlines.)
About 11 million people were enrolled in marketplace plans in early 2019, making them a relatively small part of the health insurance market. (More than half of Americans under age 65 — about 158 million people — have health insurance through an employer.)
As usual, the Obamacare marketplace offers four tiers of plans — bronze, silver, gold and platinum — based on what share of costs people must cover. Most people with marketplace coverage qualify for tax credits that can drastically lower their premiums, and many can get help covering out-of-pocket costs and deductibles.
“If you are eligible for subsidies, it can be an incredible deal,” said George Kalogeropoulos, chief executive of HealthSherpa, a web broker authorized to sell Obamacare plans.
Many parts of the country are seeing lower premiums than last year, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. Many insurers raised premiums sharply in 2018 but then “modestly” reduced them for this year and again for 2020, she said.
The average premium for a 27-year-old enrolling in the most popular silver plan fell 4 percent for 2020, according to the federal Centers for Medicare and Medicaid Services, which oversees HealthCare.gov. Some states are seeing double-digit premium declines, and more insurers are offering coverage on the marketplace, providing greater choice, the agency said.
Details vary, however, based on people’s income, the plan they choose and where they live, so some will see higher costs. Premiums may still be steep for some people who don’t qualify for the tax credits; people are ineligible if they earn more than 400 percent of the federal poverty level, or about $50,000 for a single person and $103,000 for a family of four.
While the Obamacare market has stabilized, many people remain in the dark about open enrollment. Just 5 percent of uninsured people are aware of the federal sign-up deadline, according to polling by Get America Covered, a nonprofit group that promotes health coverage.
“One of the biggest challenges is letting people know that this is the time to go and shop,” said Joshua Peck, a co-founder of the group and a former chief marketing officer of HealthCare.gov.
Through last Saturday, about 1.7 million people had chosen a plan on HealthCare.gov, down about 13 percent from the same period last year, according to numbers released by the government. (The Centers for Medicare and Medicaid Services said direct comparisons with prior years were difficult because many factors influenced enrollment. In addition, the agency said, this year’s measurement period contained one day fewer than last year’s.)
There’s typically a rush of enrollments before the deadline, so the trend could change. But Mr. Peck said it was worrisome that renewals, in particular, were down 16 percent from last year. People who don’t actively renew are automatically re-enrolled in the same health plan. But, he said, they often drop coverage in the first few months of the year because they find their plans have changed or they are getting less financial help because their income rose.
Part of the problem may be that the Trump administration has slashed funding for the marketing of HealthCare.gov as well as for independent “navigators” who help people choose plans and enroll, according to the Kaiser Family Foundation.
The Centers for Medicare and Medicaid Services said the enhanced enrollment providers must follow certain rules, like displaying Obamacare health plans on a separate page on their websites and informing shoppers that tax credits and cost-sharing help are available only with Obamacare plans.
Some states, like New York, have funded their own “assistors,” who help consumers at no charge. But other areas, including all of Utah, have no in-person navigators, a Kaiser analysis found. Consumers must seek help on the phone or may turn to outside agents or brokers.
Brokers may be knowledgeable, but some may have financial incentives to steer consumers to short-term health plans — sometimes called “junk” plans — that don’t comply with Obamacare. The Trump administration has relaxed rules for offering such plans, which have lower premiums but, unlike the Obamacare plans, don’t have to offer a specific menu of benefits and can deny coverage to people if they are ill. (Some states that run their own marketplaces don’t allow marketing of short-term plans.)
People often doubt that they will find affordable coverage on the marketplace, but most people qualify for subsidies that reduce their premiums. Two of three people can find a 2020 plan for $10 a month, Mr. Peck said.
Even if people like the coverage they had this year, they should return to the marketplace, update their information and shop, he said. The formula for determining financial subsidies is complex, and even if your plan was the lowest-priced option this year, it may not be next year.
“Go back, check and make sure the price is what you think it’s going to be,” Mr. Peck said. People who shop and switch plans save an average of 38 percent on their monthly premiums, he said.
“It may take 15 minutes,” Ms. Pollitz said, “but it’s worth it.”
Here are some questions and answers about marketplace open enrollment:
Will I pay a penalty if I don’t enroll in insurance coverage?
In most cases, no. As part of the 2017 tax overhaul, Congress eliminated the federal penalty for not having health coverage, beginning in 2019. A handful of states, however, have their own requirements and may charge a penalty on state tax returns if filers don’t have coverage.
Can I buy Obamacare plans outside the government marketplaces?
The Trump administration has authorized several web brokers and insurers to sell Obamacare health plans using what it calls “enhanced direct” enrollment.
The sites may be useful, particularly for people who don’t qualify for premium credits on HealthCare.gov, experts say. But because some sites may also sell other types of policies, consumers should be cautious and make sure the plan they choose meets Affordable Care Act standards.
Ms. Volk advised asking the broker if the plan covers the 10 essential benefits required by the Affordable Care Act, including maternity care, hospital coverage and prescription drugs. She also recommended requesting a copy of the plan’s formal “summary of benefits,” rather than making a decision based on marketing materials alone.
Be skeptical if a broker asks detailed questions about your health status, Ms. Volk said. “That’s a red flag,” she said, because Obamacare compliant plans can’t deny coverage if you have a medical condition.
HealthSherpa, one of several authorized “enhanced direct” Obamacare brokers, offers only plans that are sold on the Affordable Care Act exchange and supports enrollment in Medicaid, the federal-state insurance plan for low-income people, Mr. Kalogeropoulos said. The site aims to offer a “better and easier user experience” for shoppers by providing mobile options for enrolling and submitting financial documents.
Experts generally advise starting your search at HealthCare.gov, which will automatically redirect you to the correct site if your state runs its own marketplace. Or call the federal enrollment hotline at 1-800-318-2596.
Isn’t the Affordable Care Act being challenged in court?
Several Republican-led states, backed by the Trump administration, have challenged the law, and a decision by an appeals court in Louisiana could come any day. Most health and legal experts expect that any outcome in the case will be appealed, so coverage for 2020 is unlikely to be affected. But they worry that confusion about the case may discourage some people from enrolling.