October 28, 2016
INSURER defections and double-digit premium increases may be making consumers wary of seeking health insurance through Affordable Care Act marketplaces. But despite the turmoil, health care advocates are still urging people to shop for 2017 coverage when the annual open enrollment period begins on Tuesday.
“Go shopping,” said Elisabeth Benjamin, vice president for health initiatives with the Community Service Society in New York. “You may be eligible for more financial help than you think.”
Premiums for benchmark plans on HealthCare.gov, the federal marketplace, are increasing by an average of 25 percent, the government said. But 85 percent of those insured through the marketplace are eligible for tax credits that can significantly lower those premiums.
In many parts of the country, tax credits can reduce premium increases to “essentially zero,” Cynthia Cox, associate director of Kaiser Family Foundation’s program for the study of health reform and private insurance, said this week in a call with reporters.
And because tax credits and financial help increase when premiums increase, some people may be eligible for assistance next year even if they weren’t this year. “As premiums go up, so do premium tax credits,” said Elizabeth Hagan, senior policy analyst with Families USA, an advocacy group.
The catch is that keeping the lowest possible premium may require consumers to change plans, which can mean switching doctors — a hassle many people want to avoid, especially if they have complex medical conditions.
Still, “as long as they’re willing to shop around and change plans,” Ms. Cox said, they can save money.
About 11 million people are enrolled in marketplace plans. The federal government estimates that 2.5 million people who pay full price by buying individual coverage could qualify for financial help if they shopped on the marketplace instead.
Changes in premiums for 2017 plans vary widely, according to an analysis from the Kaiser foundation.
Cities like Phoenix and Birmingham, Ala., will have sharp increases in premiums for “benchmark” silver plans before the application of tax credits. But premiums for such plans in Indianapolis, Cleveland and Providence, R.I., will decrease.
Even in markets where just one insurer is participating, however, consumers generally have a choice of plans, Ms. Hagan said.
In New York, where the average increase is about 17 percent, Ms. Benjamin said low-income families and individuals could qualify for an “essential” plan that has no deductible and a monthly premium of either nothing or $20 a month. The option was offered for the first time for 2016, and about 360,000 people are enrolled, she said.
Here are some questions and answers about marketplace open enrollment:
When is open enrollment for marketplace plans this year?
Open enrollment runs from Nov. 1 until Jan. 31, 2017. But you must enroll by Dec. 15 if you want your coverage to start on Jan. 1.
Consumers can’t enroll in coverage until Tuesday, but they can prepare now by previewing available plans on HealthCare.gov.
Where can I get help choosing a plan?
Advocates recommend meeting in person with a trained assister or “navigator,” who can help you compare options. “This is hard stuff,” Ms. Benjamin said. “Don’t do it by yourself.” On HealthCare.gov, you can click on “find local help” to search for assistance by ZIP code. You will also find a checklist of information and documents you will need to enroll.
Advocates recommend setting up an appointment soon, so you will have time to consider options and ask questions without pressure. “Try not to wait until the last minute,” said Erin Singleton, chief of mission delivery for the Patient Advocate Foundation.
What is the penalty for going without health coverage?
The minimum penalty is now about $700 per adult.