How to preview plan premiums, benefits and networks:
- Visit HealthCare.gov to get a sense of rates.
- ‘Window shop’ on your state exchange.
- Look to your state insurance department.
- 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 2019. 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
You can always visit HealthCare.gov to browse plans and rates, and to get a general idea of how much financial assistance you’d get if you were to enroll. They let you do this 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 on HealthCare.gov more than about a week in advance of November 1, you’ll likely be seeing 2018 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.
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. You’ll also be able to see what health insurance would have cost you in 2018 (including premium subsidies if you’re eligible for them), and see which insurers are offering plans in your area. In several states, additional insurers are joining the exchanges for 2019 though, so you may see more options available once the 2019 rates are loaded into the system. That typically happens around October 25 on HealthCare.gov.
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, 2018, nearly a month before the start of open enrollment, just as they did the year before. And Covered California is starting their open enrollment period (not just window shopping) two weeks early, on October 15. This will be the schedule they use in future years as well.
In 2018, it was easier for states to finalize premiums well in advance of open enrollment. In the summer/fall of 2017, it was more challenging, due to the uncertainty surrounding funding for cost-sharing reductions (CSR). President Trump had threatened throughout 2017 to eliminate federal funding for CSR, and ultimately did so on October 12, less than three weeks before the start of open enrollment.
As a result, insurers in some states were scrambling to adjust their 2018 premiums in the latter half of October. For example, Colorado’s exchange was already in the process of loading 2018 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, which delayed the availability of window shopping.
But for 2019, that uncertainty has not been a factor. The federal government will continue to not fund CSR, but states and insurers already know that. So the cost of CSR is almost universally built into the rates that insurers started filing in the spring of 2019 (in most cases, the cost is being added to silver plan rates, which is beneficial to the majority of consumers and can result in some highly discounted bronze and gold plans for people who qualify for premium subsidies)
3. Look to your state insurance department
But even before window shopping is enabled on the exchange sites, many states — including some that use HealthCare.gov — will have 2019 rates available on their insurance department websites well before open enrollment begins. (Find your state insurance department.)
As an example, the Nevada Division of Insurance has a web page where people can select their county and age and see pre-subsidy prices well in advance of open enrollment (rates are available on that page by late September). Nevada’s page shows on- and off-exchange plans, but it doesn’t account for premium subsidies.
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 in late October.
Keep in mind, however, that if your state department of insurance publishes rates in advance of open enrollment, they’ll be the full-price premiums. If you’re eligible for premium subsidies, you’ll end up with lower prices when you eventually enroll. And premium subsidy eligibility extends well into the middle class. A family of four will qualify for subsidies with an income above $100,000 in 2019. So don’t assume you won’t get premium subsidies until you check to make sure!
4. Consult with a trained advisor
If you’re interested in having a real conversation about your coverage for 2019, you 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. You’ll be able to select from “assisters” (navigators and enrollment counselors) or agents/brokers. 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.
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 broker 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.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.