Chapter 10: Insider’s Guide to Obamacare’s Open Enrollment

You don’t have to go it alone.

Seeing all of your health insurance plan options in a single place online may not be enough. Don't be afraid to ask for help.

The Insider's Guide to Obamacare's Open Enrollment 2016-2017 EditionOpen enrollment for 2017 health plans begins on November 1, 2016. From that point, you’ll have a little more than six weeks to switch plans or enroll in a new plan if you want your coverage to take effect on January 1, 2017. Open enrollment will continue until January 31, 2017, but in most states, plan selections made after December 15 will result in effective dates in February or March 2017.

Open enrollment is your opportunity to pick a new plan, or enroll in a plan for the first time. If you’re confused about the options available to you, it’s important to know that there are people available to answer your questions and help you enroll online, in person, or over the phone, and the assistance they provide is free. Don’t feel like you have to figure all of this out on your own – you don’t.

Regardless of whether you’re already enrolled in a plan through the exchange, enrolled in an ACA-compliant plan outside the exchange, still enrolled in a grandfathered or grandmothered plan, or uninsured, it’s important to consider the options that will be available during open enrollment. That’s your opportunity to compare the new plans with what you’ve already got and see whether you’d be better off making a change.

But it can be a confusing process. The exchanges provide a one-stop shopping experience, in that they put all of the available plans in one place so you can compare them (although off-exchange plans obviously aren’t included, and in some states, there are carriers that only sell plans off-exchange).

Seeing all of your plan options may not be enough

But just being able to see all the plans in one place doesn’t mean it will be a simple process to decide which one is right for you. Here are some things to consider:

  • Provider networks vary considerably from one plan to another. Some plans are HMOs, some are PPOs, and some are EPOs. There are even tiered-network plans available in some states.
  • Prescription drug formularies (the list of drugs covered by the plan) also vary considerably from plan to plan. The ACA requires health plans to cover at least one drug in each category and class of drugs, or the same number of drugs in each category and class as the state’s benchmark plan, whichever is greater. So essentially, each type of drug is covered with at least one drug choice. But the specific drugs that are on each carrier’s formulary, and how they’re covered by the plan, differs greatly from one plan to another.
  • In most states, the default display shows plans in order of premium, from lowest to highest. So you’ll see the cheapest plans first. But those plans have the highest out-of-pocket exposure, and generally aren’t a suitable choice for people with significant health conditions or people with relatively low income, due to the high out-of-pocket costs.
  • Cost-sharing subsidies are available to people with income up to 250 percent of the poverty level, but they only apply to silver plans. That means you may have to scroll through some bronze plans before you see the plans with the built-in cost-sharing subsidies.
  • There’s a lot to understand about premium subsidies too. If you enter your income when you enroll, the exchange will automatically incorporate your premium subsidy when you select a plan. But it’s important to understand how to keep the exchange updated if your income changes, what your responsibility will be in terms of reconciling the subsidy on your tax return, and how repayment works if you end up with an income higher than you projected.

All of these issues – and more – might not be readily apparent if you’re visiting an exchange website for the first time, or even if you’ve already shopped in the exchange in the past. And although things like cost-sharing subsidies and premium subsidies don’t apply if you’re shopping off-exchange (those are only available through the exchange), the other aspects of the plan comparison process apply both on and off the exchange.

Ask for help

The solution? In every community, and over the phone, and on the web, there are exchange-certified brokers and navigators who can help you figure it out. There’s no charge for their services, and your premium will be the same whether you use their help or go it alone.

A broker will be able to assist you with questions and problems that arise after your plan is in effect, and navigators will be able to help with some after-sale issues as well, starting by 2018. A broker certified by the exchange will also be able to show you the off-exchange plans in your area, and will be able to help you decide which option is best for you.

Some online health portals are now offering phone support to help customers through the enrollment process. (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.)

In short, there’s no benefit to enrolling without help. You’ll pay the same price, and you might miss something that turns out to be important. So don’t hesitate to seek out help with the plan selection and enrollment process.

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