It's Year Two for health reform, as the online insurance exchanges open on Saturday. Here’s what to pay attention to if you're in the market for a plan.
Starting Saturday, consumers who buy their own health insurance can finally sign up for a 2015 plan. Healthcare.gov, the troubled online insurance market created by the Affordable Care Act—a.k.a. Obamacare—will begin accepting enrollees, as will the 14 state-run insurance exchanges.
This year the government opened the federal site for window shopping in advance, so you’ve been able to get a sneak peek at what’s available in your area before the formal sign-up process kicks off this weekend. Although experts can’t promise that open enrollment will run smoothly this go-around, they do think the process will face fewer problems.
If you bought insurance last year, you may figure that you don’t need to do anything in year two. Or if you went without last year, perhaps you plan to do the same. Not so fast. Read this before you make any health-care shopping decisions.
Skipping Insurance Will Cost You More
If you decided to go without health insurance in 2014, you’ll likely get hit with a penalty when you file your income taxes this April. It’ll be the greater of $95 for an adult ($285 per family) or 1% of family income.
But going without insurance in 2015 will cost you even more. For the 2015 plan year you’ll owe the greater of $325 for an adult ($975 per family) or 2% of family income, which you’ll pay with your taxes in spring 2016.
You may qualify for an exemption if the lowest-cost plan in your area would cost you more than 8% of your income, or if you went without insurance for fewer than three months.
Even If You Enrolled Last Year, You Should Shop Around Again
By now you should have received a notice from your current health plan explaining that your coverage will end December 31. You’ll also be told whether the insurer will offer that same plan in 2015 and, if so, what it will cost and how it will change, says Karen Pollitz, a senior fellow at the Kaiser Family Foundation.
If you signed up for coverage last year, or even just a month or two ago, you may think you’re all set. Why go through what was likely a taxing experience, given the technical problems the exchanges had last year? Here’s why.
First, there’s a good chance you’ll have different plans to choose from this year. Some insurers will exit the marketplaces, but many others have joined. In 35 states, the number of insurance companies offering coverage on a state exchange is increasing, according to the Kaiser Family Foundation; only two states, California and Oregon, will see a slight decline. New Hampshire, which had one insurer participate in its exchange in 2014, is adding four new insurers for 2015. In Ohio, you’ll find five new insurers, and four in Pennsylvania.
Premiums are also changing. An early analysis of monthly plan costs across 15 cities found that the premium for the second-lowest-cost silver plan, before taking any income-based tax credits into account, is decreasing by an average of 0.8%, according to the Kaiser Family Foundation. However, that’s not true everywhere. The premium for that silver plan will jump 8.7% in Nashville, for example, 6.6% in Burlington, Vt., and 6.0% in Portland, Ore. The cost will drop 15.6% in Denver and 11.4% in Providence.
You’ll want to get to know your new choices and reassess your options. “It’s a good idea for consumers to check in, see what is being offered and its cost, and make an active decision to keep their plan or make a change,” says Pollitz.
Your Subsidy Could Change (Even If Your Income Didn’t)
What’s more, if you qualified for a tax credit last year, which about 85% of exchange enrollees did, update your income information and financial assistance application and see how much of a subsidy you’ll qualify for in 2015. Even if your income hasn’t changed, the subsidy you’re eligible for may go up or down. That’s because it is based off the price of the second-lowest silver plan in your area, which could have changed.
You can use this newly updated calculator from the Kaiser Family Foundation to estimate your subsidy.
You’re Not Stuck With Healthcare.gov
While the federally run site garners most of the attention, it isn’t the only place you can sign up for a plan.
If you expect to qualify for a premium subsidy (available if your income falls between 100 and 400% of the federal poverty level), your options are somewhat limited. You’ll either have to shop on the exchange or a health comparison site that’s authorized in your state to sign you up even if you qualify for a subsidy, such as ehealthinsurance.com and gohealth.com.
If you aren’t going to qualify for a subsidy, you can buy insurance anywhere, including directly from a private insurer. Just keep in mind that if you look at only a single insurer’s plans, you may miss less expensive or more appropriate options from competitors.
For the first time this year many Walmart stores have kiosks manned with insurance agents to answer questions about your plan options. They won’t be able to sign you up in the store, however. You’ll need to call or go online to directhealth.com to enroll.
Given the complexity of your options and the sign-up process, it’s understandable if you’d like telephone or in-person help. You can find local navigators or other resources in your area, such as nonprofits and consumer advocacy groups, at localhelp.healthcare.gov.
Drag Your Feet and You Could Be Auto-Enrolled
Don’t wait until the last minute to shop, warns Pollitz. In most states consumers who have not actively chosen a new plan by December 15 will be automatically re-enrolled in their current plan, or switched to a similar one if that plan is no longer available. While you can still swap coverage even after you’ve been re-enrolled, try to avoid that headache.
In a few states, such as Massachusetts and Oregon, there won’t be any auto-renewal, says Pollitz, so if you want coverage next year you must actively renew. You also won’t be auto renewed if your insurer is exiting the market in your area.
You Could Be Locked Out if You Delay
Pre-Obamacare, you could buy an individual health insurance plan at any time (assuming you were in good enough health to be approved, of course). Now the annual open enrollment window, which runs from November 15 through February 15 this year, is the only time you can sign up for individual coverage for 2015 (and you can’t be turned down based on your health).
Unless you have what’s called a qualifying event during the year, such as losing job-based health coverage or moving to a different state, you will not be able to buy a plan, putting you at risk of paying a penalty.
Despite all of the media attention and outreach last year, many consumers who didn’t buy during the 2014 open enrollment period were surprised to find out later that they were locked out, says Carrie McLean, director of customer care at ehealthinsurance.com.
Others found themselves locked out until next year because they had lost insurance due to a life change (new job, divorce) and didn’t realize the window to buy coverage closed in 60 days. If they finally got around to trying to sign up months later, it was too late.
Since the new rules have kicked in, ehealthinsurance.com has recorded a spike in interest in short-term health plans. These plans, however, offer limited benefits and do not fulfill the requirement that you buy a qualified plan or pay a fine. All the more reason you need to shop now.