What’s in our 2019 Guide to Open Enrollment?

Our guide to buying coverage for 2019 is loaded with tips for finding plans that fit your needs and budget – even before enrollment starts

Obamacare open enrollment dates and more:

How will open enrollment be different this year?

  • Insurers are joining the exchanges in many states.
  • Premium subsidies will be slightly smaller in 2019, but they’ll grow in some states.
  • If you’re eligible for cost-sharing reductions, you’ll continue to receive them.
  • There won’t be a penalty for being uninsured in 2019, but you still need coverage!
  • Don’t expect widespread promotion of open enrollment from the Trump Administration.

The Affordable Care Act, also known as Obamacare, is still making headlines and causing confusion. But after two years of carriers exiting markets and fairly steep rate increases, we’re seeing an influx of carriers joining the exchanges for 2019 — or rejoining, after a previous exit — and average rate increases that are substantially smaller than they were for 2017 and 2018.

Open enrollment for 2019 coverage will run from November 1, 2018 to December 15, 2018 in most states (exceptions in DC and six states are explained here). The enrollment process will be the same as it’s been in prior years, with each state continuing to use the same enrollment platform it used for 2018.

Here’s what to keep in mind as we head towards open enrollment:

Insurers are joining the exchanges

You might end up having more available plan options for 2019 coverage. Insurers are joining the exchanges in Arizona, Florida, Iowa, Maine, MassachusettsMichigan, Missouri, New Mexico, North Carolina, OhioOklahoma, Tennessee, Utah, Virginia, and Wisconsin.

And if you’re in Maine, Montana, Idaho, New Mexico, or Wisconsin, you can still enroll in an ACA-created CO-OP for 2019.

Average premium subsidies will be slightly smaller in 2019, but they’ll grow in some states

The ACA’s premium subsidies are designed to increase to keep pace with the cost of the benchmark plan in each area. As premiums grow, so do premium subsidies. But starting in 2018, premium subsidies became disproportionately large in many areas, due to the way states and insurers handled the loss of federal funding for cost-sharing reductions (CSR).

That will continue to be the case in 2019, and the disproportionately large subsidies will be available in more places (for example, Vermont and North Dakota didn’t allow insurers to add the cost of CSR to premiums for 2018, but are allowing them to add the cost to silver plan rates for 2019, resulting in much larger premium subsidies. Colorado and Delaware required insurers to spread the cost of CSR across premiums for all plans in 2018, but are allowing the cost to be added only to silver plans for 2019, resulting in larger premium subsidies). So don’t pass up the opportunity to get a subsidy! Even if you’ve checked your eligibility before, make sure you do so again for 2019. As the poverty level rises each year, the income cap on subsidy eligibility also rises; it will be above $100,000 for a family of four in 2019.

But when we look at the 39 states that use HealthCare.gov, there will be a slight decrease (1.5 percent) in average benchmark premiums in 2019. Premium subsidies are tied to the cost of the benchmark plan (second-lowest-cost silver plan) in each area, so as benchmark premiums decline, so do premium subsidies. 2019 will be the first year that average benchmark premiums on HealthCare.gov have declined. But as is always the case, there will be considerable variation from one state to another. Benchmark premiums will drop by an average of 26 percent in Tennessee (making it particularly important for Tennessee residents to shop around during open enrollment!), but they’ll increase by an average of 20 percent in North Dakota.

The short story: Shop around during open enrollment. You might find that subsidies are larger in your area than they were in the past, but you could find that they’re smaller. And in order to avoid an increase in the portion of the premium that you pay, you might find that you need to switch to a different plan for 2019.

If you’re eligible for cost-sharing reductions, you’ll continue to receive them

The federal government still isn’t funding cost-sharing reductions (CSR), but insurers and state regulators figured out a workaround last fall, and its use will be even more widespread for 2019. The details are explained here, but the short story is that the cost of CSR is being added to silver plan premiums in most states, and the CSR benefits themselves continue to be available in every state.

No penalty for being uninsured in 2019, but you still need coverage!

The ACA’s individual mandate penalty will be set to $0 starting in January 2019. People who are uninsured in 2018 (and not eligible for a penalty exemption) will still have to pay a penalty when they file their 2018 tax return in early 2019. But people who are uninsured in 2019 and beyond will not face a penalty, unless they’re in a state that imposes its own individual mandate.

Going without coverage isn’t wise, though, regardless of whether there’s a penalty. And open enrollment only comes around once a year. So if you were to find yourself uninsured and in dire need of medical care in mid-2019, you’d have to wait until 2020 to have coverage.

It’s true that there will be more loosely-regulated coverage options available in 2019, thanks to the expansion of short-term plans, association health plans, and state-based alternatives to ACA-compliant plans. And there will no longer be a direct penalty for relying on those types of coverage. But they all have drawbacks, so read the fine print carefully if you’re considering them.

Don’t expect the federal government to heavily promote open enrollment

In the fall of 2017, just before open enrollment for 2018 coverage, the Trump Administration announced drastic funding cuts for exchange marketing and enrollment assistance. And in 2018, the Administration again slashed funding for Navigator programs, down to just $10 million (it had already been reduced to $36 million in 2017). The lower funding levels are likely to remain in place for the duration of the Trump Administration, and the Administration is likely to once again promote Medicare open enrollment but not individual market open enrollment.

But state-based exchanges and consumers advocates will continue to conduct outreach, and enrollment assistance will continue to be available throughout the country.

Of course, we know plan buyers have plenty of questions and concerns. The good news is that we’re again providing answers about enrollment in our updated Insider’s Guide to Obamacare’s Open Enrollment.

The “expert” behind the guide is contributor Louise Norris, whose stellar coverage of all things ACA has made her a respected source for major media who cover state health insurance marketplaces.

What’s in the updated guide?

Louise packed this year’s guide full of the information that matters most to plan buyers, including:

Have more enrollment questions?

If the guide doesn’t answer all of your questions, you’ll like find the answer you need in one of two dozen enrollment FAQs.

Helpful plan-buying tools

Here are just a few tools that can speed up you plan shopping:

What’s happening in your state?

Wondering what’s happening with premiums and plan availability in your state? Louise Norris has the latest updates on changes within your marketplace.