How to preview plan premiums, benefits and networks:
- Do a ‘drive-by’ to preview premiums and subsidies.
- ‘Window shop’ on your state exchange.
- Look to your state insurance departmen.
- Consult with a trained advisor.
- Check your provider network now.
- Talk to your current provider.
Open enrollment begins on November 1. That’s the first day you can complete the enrollment process and select a plan for 2018. But there are steps you can take before November to make sure that you’ve got all your ducks in a row.
1. Visit HealthCare.gov to get a sense of rates
As in previous years, you can visit HealthCare.gov to get a sense of plan 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.
One big problem with HealthCare.gov? If you go “window shopping” in advance of November 1, you’ll be seeing 2017 plans and rates. In previous years, the new rates and plans for the coming year became available on HealthCare.gov about a week before the start of open enrollment, but even those few days of window shopping may not be available this year.
For 2018 coverage, CMS has said that their target for getting the rates and plans available on HealthCare.gov is November 1 – the day that open enrollment starts. 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 December 15, when you’re ready to enroll in a plan.
2. ‘Window shop’ on your state exchange
State-run marketplaces / exchanges have more flexibility in terms of when they make new plans available for browsing. For example, Your Health Idaho, the state-run exchange in Idaho, debuted window-shopping for 2018 plans on October 2, 2017, nearly a month before the start of open enrollment. And Covered California made window shopping available on October 11, three weeks before the start of open enrollment.
But the uncertainty surrounding funding for cost-sharing reductions has resulted in later-than-usual state and federal deadlines for rate finalization and insurer contracts with the exchanges (ultimately, the Trump Administration announced on October 12 that they would discontinue CSR funding).
HealthCare.gov gave insurers until September 27 to finalize rates and commit to the exchange for 2018, but there is a brief refiling window available to insurers in some states in mid-October to modify rate filings in light of the Administration’s decision to end CSR funding. State-run exchanges had their own deadlines that began as early as May, but most offered at least some degree of flexibility to allow insurers to file revised or additional rates that would apply in the event that CSR funding is eliminated (as it was, in October).
The uncertainty over rates and insurer participation might result in fewer state-based exchanges being able to make rates and plans available for browsing very far in advance of open enrollment. As an example, Colorado’s exchange was already in the process of loading rates into their system when the Trump Administration announced that CSR funding would not continue. The initial rates were based on the assumption that CSR funding would continue, although the state had backup rates that included the cost of CSR built into the premiums. But the exchange had to start over on October 13 with the process of loading the backup rates into the system, and it’s likely that it will take until November 1 to get that done.
3. Look to your state insurance department
But even before window shopping is enabled on the exchange sites, many states – including ones that use HealthCare.gov – will have 2018 rates available on their insurance department web sites well before open enrollment begins. (Find your state insurance department.)
As an example, the Nevada Division of Insurance has created a web page where people can select their county and age and see pre-subsidy prices of all of the plans that will be available in 2018, both on and off-exchange. The prices won’t be on HealthCare.gov until November 1 or very near to that date, but the state had the prices available on the Department of Insurance page by late September.
Nevada’s page is very comprehensive, though — most state insurance departments tend to use averages or provide premiums for one or two specific ages (say, a 25-year-old and a 50-year-old). But these can still give you a rough idea of how much your premium might change in the coming year, even if no specific rates are available for browsing.
There are three states (Oklahoma, Texas, and Wyoming), however, where the entire rate review process is done by HHS, and final details about rate changes aren’t published until they’re made available on HealthCare.gov, which is expected to be on November 1, 2017 this year.
4. Consult with a trained advisor
If you’re interested in having a real conversation about your coverage for 2018, you still have plenty of options.
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. Similar tools for finding local enrollment assistance are available on the websites for the state-run exchanges.
Similar tools for finding local enrollment assistance are available on the websites for the state-run exchanges.
You can also use your 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 will make it more likely that you have your new insurance plan and ID card in hand by the start of the new year. Although you can technically apply any time until December 15 and get a January 1 effective date, enrolling as soon as possible gives you more leeway to deal with errors and delays that might occur.
5. Check your provider network now
Over the last few years, there has been 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 might no longer be on your current plan’s network for the coming 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 having to change health care providers — particularly if you’re dealing with an ongoing medical condition — can be nerve-wracking, 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. 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.
Do your homework, but be aware that network agreements are never set in stone. New providers can enter networks, and existing ones can leave (this can happen mid-year, despite the fact that enrollees are not allowed to switch plans mid-year without a qualifying event). This has caused confusion in the past, but new rules that were implemented in 2016 require carriers in the federally facilitated marketplace (HealthCare.gov) to maintain easily accessible, regularly updated provider directories.
6. Talk to your current provider
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 major medical 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.