As Americans sign up for Affordable Care Act marketplace insurance, a big question looms: How long will those plans last given President-elect Donald Trump’s promise to repeal the law that created the ACA exchange?
For now, those plans are still available, and Americans who want health insurance should enroll before the Jan. 31 deadline (or Dec. 15 if you want coverage to start Jan. 1). If Congress and Trump decide to unravel the health care marketplace, it may not happen immediately.
“My crystal ball is no better than anyone else’s,” says Karen Pollitz, a senior fellow at the Kaiser Family Foundation. “Generally, all of the health insurance plans are written for a plan year. … If Congress comes in in 2017 and makes some really big changes, your policy may not make it through the year.”
But repealing and replacing what is known as Obamacare could be tedious, making it likely that plans chosen this month will last through 2017.
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About 12.7 million Americans bought health insurance last year through federal and state marketplaces, according to the U.S. Department of Health and Human Services, with 7.5 million more eligible to participate. Another 9 million Americans received insurance through the ACA’s Medicaid expansion in 31 states.
The increased costs for ACA plans have received a lot of coverage. According to HHS, the premium for the second-cheapest Silver plan on the federal marketplace in the states for which data was available is up 22 percent over 2016. An analysis by the Kaiser Family Foundation found that premium changes for that same Silver plan (based on a 40-year-old nonsmoker) ranged from a decrease of 2 percent in Ohio to an increase of 145 percent in Arizona.
But the statistics may not be as meaningful as they seem. About 84 percent of ACA customers receive subsidies, which means their out-of-pocket costs will not rise that much, if at all. HHS reported that 63 percent of those using the federal marketplace could get a Silver plan for $100 or less per month.
Plus, the statistics are averages, so you may be able to avoid higher costs by changing plans. Costs also vary by geography and age, so that a 60-year-old may pay more than twice as much as a 30-year-old.
“Those numbers are largely meaningless because there’s so much variation across plans,” says JoAnn Volk, a senior research professor at the Georgetown University Center on Health Insurance Reforms.
Subsidies are available for anyone making up to 400 percent of the poverty level, which is $47,520 for a single person, $97,200 for a family of four or $163,560 for a family of eight. Those with incomes below 200 percent of the poverty level are eligible for Silver plans with lower deductibles and copays.
High-deductible plans continue to be a part of the marketplace, with a maximum deductible of $7,150 for an individual or $14,300 for a family in 2017. Those also are the maximum out-of-pocket costs.
A new kind of plan offered in many areas, called a Simple Choice plan, enables consumers to receive services such as doctor visits and some drugs for a copay before meeting deductibles.
Some consumers will choose from fewer insurance companies. Aetna and United HealthCare pulled out of the federal exchange and some state exchanges. The Kaiser Family Foundation found the number of insurers in the federal exchange in 2017 will range from one in Alabama, Alaska, Oklahoma, South Carolina and Wyoming and up to 15 in Wisconsin. However, most insurers offer multiple plans.
“On average, communities will have 30 plans to choose from,” says Claire McAndrew, director of campaign strategy for Families USA, a nonprofit organization that offers tools to help consumers with health care decisions. “It’s not a universal experience everywhere. … Health care is local. It really depends on where you live.”
Consumers should be aware that if their current insurance plan was canceled, the marketplace will automatically enroll them in a new plan. Even if your plan is still offered, key elements, including providers, copays and lists of covered drugs, may have changed. That makes it essential to review your choice every year.
“People should not assume that their plan is the same,” Volk says.
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Here are important things to know if you are enrolling in Obamacare:
Don’t trust online provider directories. Call your doctors directly to find out if they accept the plan you are considering. Online directories are often outdated, and the ACA marketplace feature that lets you add doctors and hospitals to your search may not be accurate.
Look carefully at drug formularies. Many companies change how drugs are covered from year to year, or even during the year. Find out the cost for the drugs you take regularly, and even call the company to verify coverage.
Add up all the costs. It’s tempting to choose the cheapest policy, but first consider how much medical care you are likely to use. For a healthy person, a high-deductible plan may be fine, but it could be an expensive choice for someone who uses more medical care. “Pay attention to detail,” says Lydia Mitts, senior policy analyst for Families USA. “Don’t just look at what the deductible is.” The ACA marketplace offers four tiers of plans: Bronze, which is estimated to cover 60 percent of medical costs; Silver, which is estimated to cover 70 percent; Gold, 80 percent; and Platinum, 90 percent. Most people choose Bronze or Silver plans, and those tiers have the most plan options.
See if you qualify for a subsidy. Premium tax credits are provided to customers based on their adjusted gross income. If you have a variable income and you guess wrong, you can make adjustments any time during the year or settle up at tax time. If you overestimated your income, you will get a refund. If you underestimated your income, you will owe more in taxes.
Check your special cost-sharing plan eligibility. If your income is less than 200 percent of the poverty level, you are eligible for Silver plans with lower copays and deductibles. But those plans won’t appear in your search if you estimate a higher income. If you underestimate your income, you will have to pay the subsidy difference, but there is no additional penalty.
Consider using a health savings account. Some high-deductible plans allow you to save up to $3,400 (plus $1,000 more if you’re 55 or older) tax-free in a HSA to cover health care expenses. You can carry unused money over from year to year.
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Know the penalty for not having insurance. The penalty for 2017 is $695 per adult and $347.50 per child or 2.5 percent of your income, whichever is higher, up to the national average annual cost of a Bronze insurance plan. Those who do not have access to affordable insurance will not have to pay a penalty.
Get in-person help. Digging through all the plans can be difficult, especially if you’re not computer savvy. Luckily, you can find help in your community.
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How Affordable Care Act Marketplace Insurance Plans Will Change in 2017 originally appeared on usnews.com
