On Nov. 15, you’ll have the chance to shop for health insurance plans through “marketplaces” established by your state or the federal government, as the second year of the Affordable Care Act, or Obamacare, begins.
The decisions you make during open enrollment could save you money and make seeing the doctor easier in 2015, whether you are currently uninsured and need coverage, have coverage and want a change, or even if you are satisfied with your current plan.
The initial Obamacare open enrollment period was rife with problems: website glitches, confusing navigation, canceled plans and affordability concerns. Some people chose to skip enrolling altogether, opting instead to face a penalty. Among those who are still uninsured, 59 percent plan on getting health insurance in the coming months— but some 89 percent of them don’t even know that open enrollment begins in November, according to a survey from the Kaiser Family Foundation.
With the Congressional Budget Office estimating 13 million people will sign up for ACA coverage on insurance exchanges for the 2015 coverage year, and many states making changes to their online portals for health coverage shopping, there are no guarantees this year’s open enrollment will go any more smoothly. But arming yourself with information in advance could save you some frustration when the time comes.
Open Enrollment Basics
Open enrollment begins on November 15 and runs through February 15, 2015. The changes you make during this time will affect your health insurance coverage in 2015. Barring a special enrollment period or qualifying life event (like marriage, job loss or the birth of a child), this is the only opportunity you’ll have to make changes to your 2015 health coverage.
Obamacare open enrollment affects those who are uninsured, who purchased their current plan through an ACA exchange last year, who work for small businesses that take part in the SHOP Marketplace, and people interested in switching from their current insurance. If you’re satisfied with your current marketplace plan and take no action, you will automatically be re-enrolled in the same plan for 2015 (re-enrollment specifics vary on state exchanges). But even if you’re happy with your current ACA plan, potentially rising premiums and other policy changes could give you reason enough to comparison-shop.
On average, rates are expected to increase 6 percent, according to an analysis from PricewaterhouseCoopers Health Research Institute. But these premium changes vary widely from state to state and plan to plan— some will see decreases of up to 22 percent, or increases as much as 35 percent.
Even if your current carrier doesn’t plan on raising rates, you could end up paying more. Premium tax credits, created to make health insurance more affordable, are based on the rate of silver benchmark, or mid-level, plans in your area. If new plans come into play, that benchmark plan rate could be lower— meaning your tax credit could be lower as well, even without a change in income, which leaves you with a bigger balance to pick up.
Your insurance plan may undergo additional changes, like additions or reductions in the doctors you can visit in-network, changes in copays and out-of-pocket expenses, or changes in what prescription medications are covered. Further, any changes in your income could impact how much you pay in the coming year.
What You Should Do
If you already have a plan that you’re happy with, your first priority should be to determine what your carrier has planned for the coming year. If the differences are minimal from 2014 to 2015, sticking with the same plan may not be a bad idea. But you should update your information (including any changes to your address or contact information, new family members, etc.) and comparison-shop to ensure a better plan isn’t out there.
Regardless of your past year’s coverage, there are certain things everyone should do going into open enrollment:
1. Accurately report and update your income information.
You’ll want to take advantage of the premium tax credit and cost-sharing subsidies if possible, but underestimating your income could result in you having to pay back some of what you saved at tax time.
2. Estimate your health care expenses for 2015.
Though trying to determine next year’s health needs may be difficult, you should aim for a ballpark figure that includes regular doctor’s visits, prescription costs and any expected surgeries or treatments.
3. Study all of your options.
Don’t only compare your premiums, but also consider out-of-pocket expenses, network size and consequences of going out-of-network, covered services and prescription drug coverage.
4. Compare these coverage options with your estimated costs and expected credits.
This will help you determine how much your share of health care expenses would be under the plans you’re considering.
Open enrollment and health coverage can be confusing, so don’t be afraid to ask for help. State exchanges and the government Marketplace offer assistance by email and phone, and some consumers find that talking with a real person about their options makes the process easier.
Because the decisions you make now will last a year, it’s important to get them right. Ultimately, regardless of how you feel about Obamacare, your health coverage choices can affect both your physical and financial health.