It’s open enrollment season for health insurance. And this year there’s much more confusion than in past years, given the events in Washington. Don’t worry: I’ll break it all down for you in this, the only guide to buying health insurance you’ll need this year, with links to in-depth, trustworthy resources.
Your choices will be quite different this year, partly because state regulators and individual insurers are reacting differently to the events in Washington. Also, in many cases, the government tax credit subsidy to people who buy insurance on the exchanges has changed – so even if you didn’t qualify last year, you might this year.
The tips here are most useful for people who are getting health insurance under the Affordable Care Act, outside of employer-sponsored offerings – those who use either healthcare.gov or the insurance exchange in their home state (California and New York, for example). If you have an employer-sponsored plan, you too will be required to know more than in past years, but your questions are likely to be different from those of A.C.A. customers.
For Affordable Care Act purchasers, the administration has cut the advertising budget that was intended to encourage enrollment as well as cutting funding for navigators, the people paid to advise enrollees about the subtleties, making it harder to know what to do.
The administration also cut the enrollment period to Nov. 1-Dec. 15 , for coverage beginning Jan. 1, 2018, in the states where healthcare.gov, the federal site, runs enrollment; in states that have their own exchanges, enrollment deadlines can be as early as Dec. 15 or as late as Jan. 31 for 2018 coverage. Know your deadline.
Another big hurdle for all of us: Information is fragmentary and seems to be changing constantly. This brings anxiety, and it also threatens your ability to be calm and do your best research. Stay calm. Do your homework.
In preparation, you’ll want to do all the normal things – think ahead. If you’re planning to have a baby or major surgery, for example, you’ll choose to go one way. If you don’t expect to have big spending, you’ll go another way. Check that your providers are indeed in the network of the plan you’re contemplating. If you have big medication expenses, you’ll factor those into your decision, just as in previous years.
But this year is different on several levels. Here are our five smart tips.
- Do your research carefully. Decisions will vary greatly state by state, and family by family. For example, you may qualify for tax credits this year, even if you did not last year. About 80 percent of people who buy insurance on the exchanges qualify for a the tax-credit subsidy – so don’t be scared by a sticker price on a plan, but rather go through the entire process of inputting your income, number of children etc. Resist the impulse to take the “silver is always better” advice from people who don’t know your situation and your state’s regulatory decisions. Resist the impulse to renew what you had last year, because there have been big changes. This is all mind-numbingly complicated, and we will all of us hate our insurers forever. But we must plow ahead, and research carefully.
- Look at this site, and this state-by-state breakdown for insights. Charles Gaba is a web developer in Michigan who has become a national expert on the arcane ways of the A.C.A. He and some colleagues did amazing research on the effects of the administration’s last-minute decision to throw into doubt the payments made to insurers to ease out-of-pocket costs for some insured people (the Cost Sharing Reductions), and other factors. He credits fellow A.C.A. nerds Dave Anderson (Balloon Juice), Louise Norris (healthinsurance.org) and Andrew Sprung (Xpostfactoid) for assistance. Their work fills an important gap with the cut in navigators. Without going into deep detail, I strongly suggest that you read this post and then keep an eye on Gaba’s site and this spreadsheet for updates and this explainer for details if you want. In some states, for example, a silver plan can cost more than a gold plan this year, depending on your income. In some states, a bronze plan will be free, depending on your income. Last-minute changes are still turning up. (Disclosure: Gaba and I talk from time to time, though we have never done business together.)
- Look outside the exchanges. You might think you are better off on the exchange in your state, or that you don’t qualify for a tax credit subsidy. If you don’t qualify for a subsidy, you might well be better off outside of the exchange. In New York State, where I live, some insurance companies are selling individual plans both on the exchange and off the exchange — and some are selling little or no individual business directly, off the exchange. Gaba’s advice: “The main point is that EVERYONE should shop around REGARDLESS of which state they live in since there are so many other variables. If someone is 100% certain that they don’t qualify for subsidies, they should make sure to compare on- and off-exchange options.”
- Ask friends and neighbors. Many of us do this already, but this year it makes even more sense. You may find official assistance, though even if you can, real people may know more than a navigator or an off-exchange broker (a broker, too, is probably making money by selling you something). In my village, for example, there’s a Facebook group of people researching this topic with information like “Susie at Medical Group A says they won’t be taking Insurance X this year” or “I found this broker through a friend – he sells off-exchange policies and may be a resource. Please report back.” Or “This broker says he’s the only one, but I found this one too.” Or “I searched my GP and the insurer’s website says she isn’t a participating provider — but another doctor in her practice is. Then I called the doctors’ billing department and they told me if one doctor in the group participates they all do.”
- See if you have any non-obvious opportunities, like a union or trade group. We hear that many people find USAA to be a good choice, but it requires a military affiliation in your family. Others may have access to a Chamber of Commerce insurance plan. Here’s a list of organizations compiled by PEN America, the writers group, listing options that you may not have thought of as membership organizations. One example: A friend’s wife is a lighting designer, and she’s insuring him through her union membership.