It’s been a tumultuous year for the Affordable Care Act, with President Donald Trump and congressional Republicans working tirelessly for months to deliver on their long-time promise to repeal and replace the law.
But for all the activity and Trump’s proclamations of Obamacare being dead, it’s still the law of the land. Open enrollment starts Nov. 1 and runs through Dec. 15. Subsidies are still available to help people cover the cost of health insurance, and the mandate for most Americans to have coverage to avoid paying a tax penalty remains in place.
But there’s no denying that talk of Obamacare repeal has left consumers feeling confused. If you buy insurance on your own, you may be wondering: How will the health care debate in Washington affect me?
Here are six things to know about the 2018 open enrollment season.
This Year’s Enrollment Period Was Cut in Half
The Trump administration cut this year’s open enrollment period from 12 weeks to just six weeks in the 39 states where consumers shop for coverage on the federal marketplace, Healthcare.gov.
If you live in a state that operates its own marketplace — say, California or New York — you may have extra time to select coverage for 2018. Both states, for example, will hold open enrollment through the end of January, as they have in years past.
One group likely to be impacted by the limited sign-up period is young people who tend to enroll at the last minute, says Linda Blumberg, senior fellow at the Urban Institute. If you have a 20- or 30-something in your life, give him or her a call to say it’s time to pay attention to their health benefits, Blumberg says.
[Read: How the Health Care Debate Is Impacting Medicare.]
Outreach and Advertising Have Been Cut
During past open enrollment periods President Obama and members his administration took to the road and the airways to promote the law’s open enrollment period.
Don’t expect the same from President Trump. The administration has mostly been mum on the sign-up season and recently announced a 90 percent cut in spending for advertising and outreach this year. Grants for grassroots organizations, such as community health centers, that help people sign up for health insurance through the law’s marketplaces were also reduced by 40 percent.
While a host of outside groups and business coalitions are working to pick up the slack to get the word out, it will be tough to match the power and reach of the federal government. And without the advertising push, many people simply won’t know they have access to health insurance, and in many cases, subsidies to help them afford it.
A recent poll by the Kaiser Family Foundation found that among people who remained uninsured, nearly 7 in 10 didn’t know when open enrollment under the ACA started, and 81 percent didn’t know when the period ends. That’s expected to cause a drop in the number of people enrolled in coverage next year by 7 to 13 percent, according to estimates by S&P Global.
Fewer Plan Options
A combination of low enrollment, high medical costs and growing uncertainty caused by the ongoing Obamacare repeal debate in Washington led some insurers to back out of the marketplaces for 2018.
According to the Kaiser Family Foundation, this year an average of 4.3 insurers per state participated in the marketplaces. That number will drop to 3.5 insurers per state in 2018.
Nearly half of all counties across the country will have just one insurer selling plans in their market next year. But, says Sabrina Corlette, research professor at Georgetown University’s Health Policy Institute, “Even in the counties with just one carrier, people will have a choice of plans.”
At a minimum, there should be a Bronze, Silver and Gold plan to choose from — each tier with different costs associated with doctor visits and other medical services. And you may have a choice among HMO and PPOs or other types of provider networks.
[Read: Medicare Open Enrollment: What You Need to Know.]
Cost-Sharing Subsidies Are Still Available
News of President Trump’s decision to stop paying for the cost-sharing subsidies that lower deductibles, copays and coinsurance for people with low incomes won’t affect eligible consumers. Insurers are still required to pass these savings along to individuals earning a little more than $30,000 per year, or a family of four making as much as $61,500.
Premiums Will Rise, But Not for Everyone
In response to the Trump administration’s decision to cut off cost-sharing reduction payments, insurers raised their premiums for 2018 more than they would have otherwise to make up for the shortfall.
Although states took different approaches, most directed insurers to load the additional cost increase onto Silver-tier plan premiums. Kaiser Family Foundation found that nationally the lowest-cost Silver plan being sold on Healthcare.gov is rising by an average of 35 percent, as compared to the lowest-cost Bronze plan increasing by 17 percent and Gold plans rising by an average of 19 percent.
Because premium tax credits are determined by the cost of the second-lowest-cost Silver plan in each area, the spike in prices means that people who qualify will receive much higher tax credits. The upshot is that the 84 percent of consumers buying insurance through the exchanges and receiving premium tax credit subsidies won’t feel the price increase. Ironically, many will pay less in 2018 for health insurance than they did this year.
As Kaiser Family Foundation points out in its recent analysis of 2018 premiums, this dynamic will cause the lowest-cost Gold premium, which covers an average of 80 percent of medical costs, to be cheaper than the least expensive Silver plan (which covers just 70 percent of costs) in 459 counties in the U.S.
Bronze plans, which offer less robust coverage but lower premiums, will be much cheaper next year. In fact, most consumers with incomes of $25,000 or less will be eligible for a Bronze plan with no monthly premium.
“It’s more important than in the past to look at premiums in different tier levels,” Blumberg says. With charges piled onto the Silver plans, she says, “it may make sense to buy another metal level.”
[Read: Why Do You Need Health Insurance?]
Shopping Is Essential, Especially for Higher Earners
There are nearly 7 million people in the private health insurance market who earn too much to qualify for subsidies, and they’ll be the ones to bear the brunt of next year’s steep premium increases.
“If you want a major medical insurance policy that provides decent benefits and the kind of financial protection insurance provides, many people will have to pay more for it,” Corlette says.
For that reason, shopping for a better option is essential. With all the changes in plans and prices, you’ll want to check carefully that your doctors and hospitals participate in the plans’ networks, that your medications are covered and understand what costs you’ll face when you go for care.
Corlette adds that if you’re unsubsidized, in most states you may be better off buying a plan outside the marketplace. Working with insurance agents or web-based brokers that let you view plans side by side can be a good way to compare your options. If you are eligible for a subsidy, web-based brokers can also help you sign up for a marketplace plan this year without having to go directly through Healthcare.gov.
And beware of the marketplace automatically re-enrolling people currently enrolled in a plan unless they go back to the marketplace to shop. This year’s date for auto-renewal is expected to be Dec. 16 — one day after open enrollment ends. If you’re assigned to a plan you don’t want, you’ll likely be stuck with it until open enrollment comes around again next year.
Given the shorter open enrollment period and all the changes this year brings, Blumberg offers some basic open enrollment advice: “Get on it right away and stick with it. You’ve got less wiggle room this year.”
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How Does the Health Care Debate Affect Obamacare Open Enrollment? originally appeared on usnews.com
