Chapter 4: Insider’s Guide to Obamacare’s Open Enrollment

3 ways to set yourself up for enrollment success

Even before open enrollment starts, you can get your ducks in a row by researching plans and costs, even identifying a plan with an agent

  • By
  • healthinsurance.org contributor
  • August 21, 2016

The Insider's Guide to Obamacare's Open Enrollment 2016-2017 EditionOpen enrollment begins on November 1. That’s the first day you can complete the enrollment process and select a plan for 2017. But there are steps you can take before November to make sure that you’ve got all your ducks in a row.

Online, in-person, and phone support are available year-round if you have questions in advance of open enrollment.

1. Do a ‘drive-by’

HealthCare.gov will allow you to see estimated premiums and subsidies by answering a brief series of questions – all without creating an account or providing any personal information. The prices shown won’t account for tobacco use, which will be factored into the premium when you enroll.

But if you go window shopping very far in advance of November 1, you’ll be seeing 2016 plans and rates. For the last two open enrollment periods, rates and plans for the coming year became available on HealthCare.gov only a week before the start of open enrollment

If you go on HealthCare.gov prior to that, you’ll have the option to create an account – complete with your personal data – and then log back into it between November 1 and January 31, when you’re ready to enroll in a plan.

State-run exchanges have more flexibility in terms of when they make new plans available for browsing. Covered California, for example, announced 2016 plans and rates in July 2015, and made them available for window shopping months in advance of open enrollment (for 2017, they’re advising shoppers to return to the site in October 2016, and will unveil a “new and improved shopping tool” at that point). Many states – including ones that use HealthCare.gov – will have 2017 rates available on their insurance department website well before open enrollment begins (find your state insurance department).

There are four states (Missouri, Oklahoma, Texas, and Wyoming) where the entire rate review process is done by HHS, and rates aren’t published until window shopping is enabled on HealthCare.gov. In those states, health insurers had to submit proposed 2017 rates to HHS no later than May 11, 2016, and proposed rates were publicized on Healthcare.gov’s rate review tool by August 1, 2016.

In the rest of the states, rate proposals had to be submitted to state regulators by whatever deadline the state established, as long as it wasn’t later than July 15, 2016. Regulators are completing the rate review process over the summer, and will publish 2017 rates once they’re approved (as of mid-August 2016, seven states had published their approved rate increases for 2017)

2. Be first in line for a human

You can contact a navigator or broker in your area now and set up an appointment for a phone or in-person meeting during open enrollment. Having an appointment already on the calendar will help you beat the rush and ensure that you’ll have the help you need.

HealthCare.gov includes a Find Local Help tool that allows you to easily search for approved brokers and navigators in your area. Be aware that the default setting on HealthCare.gov shows navigators and enrollment counselors (not agents or brokers) first, and you have to click on the tab that says “agents and brokers” in order to see them. Navigators and enrollment counselors can help you with the logistics of the enrollment process, but they cannot make plan recommendations.

You can even use the phone to “pre-shop” for a plan with a licensed agent – to discuss your personal plan benefit needs, get premium information and get specifics on your subsidy eligibility and subsidy amount. (You can call one of healthinsurance.org’s partners at 1-844-608-2739 to talk with a licensed, exchange-certified brokers who can enroll you in an ACA-compliant plan.)

Having your details worked out so you can enroll in November is especially critical if you need your coverage to take effect on January 1, 2017. Although you can technically apply any time until December 15 and get a January 1 effective date (the deadline is December 23 in Massachusetts, Rhode Island, and Washington), enrolling as soon as possible gives you more leeway to deal with errors and delays that might occur, and makes it more likely that you’ll have your new policy in hand by the start of the year.

3. Start “networking” now

Over the last few years, there has considerable public concern (and plenty of outcry from critics) about “narrow networks” – provider networks that have been downsized by insurance carriers as they attempt to control their bottom lines. And it is true that narrower networks could mean that your doctor or your health care facility is no longer part of your carrier’s plan this year.

I do want to note that “narrower” networks aren’t necessarily cause for alarm; health outcomes do not suffer with restricted networks. But I also understand that change is harder for some folks than others and that a changed provider may be a deal breaker.

If keeping your doctor and provider is critical to you, it’s important that you check now with the health insurance carriers in your area and your own doctors’ offices to get up-to-date network information.

It’s possible that you may have heard stories of doctors’ offices telling patients that they “didn’t take Obamacare” during the previous open enrollment periods. But Obamacare is not an insurance policy; it’s a law. All new health individual and small group insurance policies issued from January 1, 2014 onwards – including plans sold in the exchanges and those purchased directly through carriers – are compliant with Obamacare. Expanded Medicaid is also part of Obamacare.

Even if your doctor’s office says they “don’t take Obamacare,” you may find that there are ACA-compliant plans that include your doctor on their network. If keeping your doctor is important to you, have a conversation about acceptable plans in advance of open enrollment.

Do your homework, and be aware that network agreements are never set in stone. New providers can enter networks, and existing ones can leave. This has caused confusion in the past, but new rules for 2016 require carriers in the federally facilitated marketplace (HealthcCare.gov) to maintain easily accessible, regularly updated provider directories.

Carriers must update their provider directories at least monthly, and the directories must include information about which providers are accepting new patients, along with their specialty, location, and contact information. In addition, the directory must be easily available online without requiring the user to create an account or enter a policy number.

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