The third open enrollment period under the Affordable Care Act got underway on Nov. 1 and will run through the end of January.
Each year at this time, experts urge people to shop for a new health plan, even if they’re happy with the coverage they already have. That’s because health plans make changes to both benefits and costs, and shopping will likely help you save money. A recent analysis by the government found that people with Marketplace coverage who switched plans within the same metal tier in 2015 spent nearly $400 less for the year on premiums, after tax credits, than they would have if they stayed in their same plans.
Although open enrollment ends on Jan. 31, 2016, you’ll need to sign up by no later than Dec. 15 if you want your new plan in place by the start of the new year.
Here are some details to consider when shopping:
Changes in premiums. You’ll see a bigger jump in premiums for 2016 than in previous years: an average of 7.5 percent for benchmark plans, which are the second lowest cost silver plans sold in each market and the plans to which tax credits are tied.
But averages don’t speak to the wide range of price swings happening around the country.
Costs will rise much higher in some states — and even within specific markets — than in others. Nationwide, benchmark plan price changes between 2015 and 2016 range between -23 percent in some markets to 48 percent in others.
An analysis by the Kaiser Family Foundation of plans being sold in 13 states found that the benchmark plans are changing too.
“Only in one of those areas is the benchmark plan for 2016 the same as 2015,” says Karen Pollitz, senior fellow with Kaiser Family Foundation. “So it’s not just how much is your rate changing, but what’s happening with the benchmark plan because that’s what your subsidy is tied to.”
The good news is that most people will have plenty of plans to choose from, and in most cases, should be able to offset cost increases by shopping and switching plans.
Out-of-pocket costs. Too often, consumers focus exclusively on the monthly cost of their plan — the premium — and overlook other expenses that can lead to higher-than-expected medical bills.
“A lot of clients tell me they are really focused on the premium,” says Craig Gussin, a San Diego-based insurance broker and vice president of public affairs for the California Association of Health Underwriters.
Gussin offers an insider tip: “If the premium for your plan dropped [for 2016], the out-of-pocket costs probably went up,” he says. “The devil is in the details.”
Review carefully what you’ll be required to pay in the form of deductibles, copays and co-insurance when you go to the doctor or fill prescriptions.
Use available tools offered by many online brokers, such as eHealth and Stride Health, that can help determine which plan is likely to best cover your needs. This year, Healthcare.gov has a cost calculator as well.
Provider networks. In 2016, there will be fewer plans available on Healthcare.gov that allow for any access to out-of-network health care providers. An analysis by Avalere, a health consulting firm, found a 31 percent decline between 2014 and 2016 in health plans sold on Healthcare.gov that offer out-of-network coverage.
Plans with smaller networks that include fewer doctors are generally cheaper. Just know what you’re getting into. Seeing a doctor outside your health plan’s network can lead to high unexpected costs.
“If you have a doctor you like, check [your plan’s provider directory] and ask the doctor if he or she is still accepting the insurance. If they don’t and you want to stay with the doctor, you may be forced to change plans,” Gussin says.
Drug formularies. High drug costs have gotten a lot of press these days, and research shows the cost of prescription medications is a top concern for consumers.
“What most people do not know is that every Obamacare plan covers prescriptions differently,” says Nate Purpura, vice president of consumer affairs at eHealth.com.
For example, Purpura points out that while some plans have a separate deductible for prescription drugs, many include prescription drugs with the overall medical deductible. That means you may have to pay out the full amount, an average of $3,200 for silver-level plans, before getting any help with the cost of your prescriptions.
eHealth offers a new prescription drug tool that looks up the cost of your medications, then searches all the health plans available in your area to see which cover your drugs. Finally, it analyzes how your drugs are covered by each plan to show you which options will save you the most money out-of-pocket.
Take advantage of tax credits. Tax credits are available to help lower the cost of insurance for individuals earning between $11,770 and $47,080 per year.
Yet, more than 9 million people eligible for tax credits failed to take advantage of them this year, according to the Kaiser Family Foundation. Two million people who qualified for reduced costs when they went for medical care — those with annual incomes below about $29,000 — also missed out on available financial help.
“There seems to be evidence that not everybody eligible for one of these cost-sharing plans is signing up for them,” Pollitz says.
Update your information. If you’re already getting a tax credit and don’t renew your plan through Healthcare.gov, your income will be automatically updated by the government with the most current information available. If you failed to file 2014 taxes, however, you’ll have to do that now and then go back to Healthcare.gov to sign up for coverage.
Even if little about your situation has changed, update your financial information in the system if you’re currently getting a subsidy, Pollitz advises.
“An analysis we did showed that only 5 percent of people hit the number right on the nose,” says Pollitz of the income estimates you have to make when applying for a tax credit.
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Examining Your Options Under Obamacare originally appeared on usnews.com
