Despite all of the attempts to repeal and replace Obamacare this year, the law still stands. If you buy health insurance on your own, you have six weeks starting November 1 to sign up for 2018 coverage on Healthcare.gov. If you miss the deadline, you could end up with no coverage or a policy that doesn’t meet your needs. Or, you could pay more than you have to. Here’s what you need to know to cut through the confusion and pick the best plan for you during open enrollment this year.
1. You have less time to pick a plan. For the 39 states that use Healthcare.gov, open enrollment runs from November 1 to December 15—rather than until January 31, as it did in the past. Most of the 11 states and the District of Columbia that run their own marketplaces have later deadlines, such as January 31 in California and New York. If you’re already in a plan in a Healthcare.gov state, you’ll automatically be re-enrolled if you don’t do anything by the end of December 15. But by then you won’t be able to switch plans if you change your mind. And if your plan has left the business, the marketplace will likely pick a plan for you, which could have different premiums, provider network or drug coverage than you had before. “The advice has always been to actively shop and not rely on auto-renewal, and this year that is especially good advice,” says Karen Pollitz, a senior fellow at the Kaiser Family Foundation.
2. Look at all of your options. Fewer insurers may be offering policies in your area. The average is currently 4.3 insurers per state offering marketplace coverage, and that number is expected to drop to an average of 3.5 insurers per state in 2018, says Pollitz. But even if you’re in a state that offers only one or two insurers, you still may have several options from those companies. For instance, your choices may be bronze, silver and gold plans with different premiums, deductibles and cost-sharing, and possibly different provider networks. Go to Healthcare.gov starting on November 1 or find a link there to your state marketplace to research plans in your area.
3. Don’t decide based on sticker price alone. If your income is below 400% of the federal poverty level ($48,240 for a single person, $64,960 for a couple or $98,400 for a family of four), you’ll get a tax credit to help pay premiums. Use the calculators at the marketplace to figure out how much you’d actually pay for the policy, rather than going by only the sticker price. The size of the subsidy in each area is based on the second-to-lowest-cost silver policy. So if those premiums are higher than usual (which they are in many states), then you might qualify for a larger subsidy to cover your premiums. Also, if your income has changed since last year, be sure to input your current income figures at the marketplace so you’ll get an accurate subsidy. That way you won’t end up with less than you qualify for or get too much and have to pay it back at tax time.
4. Cost-sharing subsidies still exist. If your income is below 250% of the federal poverty level ($30,150 if single, $40,600 for couples and $61,500 for a family of four), then you also qualify for a subsidy to help pay your deductibles and co-payments, in addition to the premium tax credit. Even though the Trump administration announced that it will no longer reimburse insurers for this subsidy, the companies must continue to offer it to eligible people who buy a silver-level policy. If your income is below 250% of the federal poverty level, look carefully at the coverage details for silver plans.
5. You may get a good deal from a bronze or gold policy. Because insurers did not know whether the government would continue to reimburse them for the cost-sharing subsidy, many boosted their premiums much more for silver plans than for bronze and gold policies (details vary by state). The premium tax credits are based on the cost of silver policies, however, so people who qualify may get a larger tax credit than they had in the past. You can use the tax credit to pay for any metal-level policy on the marketplace. And it could go a long way toward paying for a bronze or even a gold policy—and may even cover the full premium. “In some instances, consumers should be able to find a $0 premium gold plan or bronze plan,” says Howard Yeh, CEO and co-founder of HealthCare.com, which includes policy information and prices for all of the federal marketplace states and most other states.
6. Shop off the marketplace, too. If your income is near the cutoff or too high to receive a subsidy, check out policies sold off the government marketplaces. These policies don’t come with subsidies, but the coverage must generally be the same as on the marketplace. Premiums and networks may be different, though. You can’t find off-marketplace policies at Healthcare.gov. Find them at websites such as eHealthInsurance.com and HealthCare.com or by contacting a local agent. “Off-exchange plans often have larger provider networks,” says Yeh. (HealthCare.com and eHealthInsurance.com include prices for both on- and off-marketplace policies.) If you think your income may drop below 400% of the federal poverty level during the year, however, you may still want to buy a policy on the marketplace. You generally can’t switch into a marketplace plan and get a subsidy midyear if you didn’t buy a policy on the marketplace during open enrollment, unless you qualify for a special enrollment period (see Healthcare.gov for details).
7. Review coverage and out-of-pocket costs. Besides premiums, compare coverage details, provider networks, drug coverage, deductibles, co-payments and other out-of-pocket costs. A plan with a low premium may end up costing you more by the end of the year if you have a large deductible and high co-payments for health care and drugs. Add up the potential costs for the care and drugs you typically use; eHealthInsurance.com, for example, has a tool that compares the out-of-pocket costs for your drugs under the plans in your area. Also find out whether your doctor and local hospitals are included in each plan, and whether any coverage for out-of-network care is provided. Some plans charge higher out-of-pocket costs if you go out of network, and others don’t provide out-of-network coverage at all except for in emergencies.
8. Find out if the policy is HSA-eligible. Many people choose to reduce their premiums by raising the deductible they have to pay before coverage kicks in. If your deductible is higher than $1,350 for individual coverage or $2,700 for family coverage in 2018, you may be eligible to contribute to a health savings account. An HSA can help stretch your health care dollars by giving you a triple tax break—your contributions are tax-deductible, they grow tax-deferred and can be used tax-free for health care costs in any year. But not all high-deductible policies are HSA-eligible, so check with the insurer before making a choice.
9. Get help. The government has cut funding for navigator programs that assist people with health insurance enrollment and questions. But you still can find some help in your area. Use the Find Local Help tool at Healthcare.gov to find trained assisters, brokers, insurance agents and nonprofits to help you enroll in a marketplace plan.
10. Don’t wait until the last minute. There’s usually a rush to sign up for coverage just before the deadline, and it’s likely to be even busier this year with the shorter open-enrollment period. Also keep in mind that Healthcare.gov is going to be shut down for maintenance on most Sundays throughout open enrollment. Start researching your options as soon as open enrollment begins on November 1, and make your decision well before December 15.