Getting Ready for Open Enrollment
If you need to sign up for individual health coverage through the insurance marketplace for 2018, you will have to do so during open enrollment, running November 1 through December 15. While Congress’s efforts to repeal the Patient Protection and Affordable Care Act have dominated headlines this year, the law — also known as the ACA and Obamacare — remains in place.
But the Trump administration has made some changes in how it will run open enrollment. Living Beyond Breast Cancer wants to help you be ready, so you can focus on finding coverage that will best protect your family.
Keeping health insurance without any gaps in coverage is important to protect you from the worst financial costs of cancer treatment. If you do not get insurance through an employer, the marketplaces at Healthcare.gov can help you find a plan that fits your budget and needs. The website will let you know if you qualify for government health coverage through Medicaid, or for subsidies to help pay your monthly premiums. These subsidies have not been affected by recent announcements and will continue to be paid unless another law is passed.
Open enrollment is the period every year when you can shop for a new insurance plan on the marketplace run by your state or the federal government. You sign up for the whole year and pay premiums every month. If you get sick, insurance pays a share of the medical costs, which varies depending on the plan you join. Insurance companies rely on consistent enrollment to pay for expensive treatments.
If you miss open enrollment, you will only be able to buy or change your insurance plan if you go through an event like moving to a new state, losing a job or having a baby, which qualify you for a special enrollment period.
If you already have coverage through your job, Medicare, or Medicaid and plan to continue the same coverage you do not have to go through open enrollment.
How Will Open Enrollment Be Different This Year?
Fewer Weeks to Sign Up
Early last year President Donald Trump and the Department of Health and Human Services announced changes to the way it would administer the ACA. One of the most notable changes was to cut the open enrollment period in half, from 12 weeks to just 6. Instead of running through the end of January, as it had under former President Barack Obama, open enrollment this year will start November 1 and end on December 15. Experts worry that this could lead to a significant drop in enrollment because people may not realize that the period has been shortened.
Set a date between November 1 and December 15 to search for a plan and enroll. Choose a date as early in the period as possible in case you have any problems or something comes up. After December 15 you will not be able to sign up for insurance through the marketplace unless you have a special enrollment period.
Website Down for Maintenance
Healthcare.gov will be shut down for 12 hours, between midnight and noon Eastern Standard Time, for five Sundays during open enrollment. Only December 10, the last weekend before enrollment ends, will you be able to access the website on a Sunday morning.
This is important to remember if you try to enroll very late on Saturday nights as well. Enrolling takes time, and if you think you won’t be able to complete the process before midnight you may want to choose another time to avoid losing your progress. This is especially important for people on the West Coast, where the website maintenance will fall between 9 p.m. Pacific Standard Time on Saturday and 9 a.m. PST on Sunday.
Plan ahead. Set aside a few hours on your calendar to make sure you enroll.
Outreach and Assistance
At the beginning of September, Trump announced major cuts to outreach funding that shut some offices down immediately. The administration has also pulled out of state-level partnerships that provide information to residents about open enrollment and how to sign up for insurance. Getting more people to buy insurance is important to keeping insurance plans available and affordable. It also means fewer people getting fined, fewer people at risk of medical bankruptcy if they get sick or injured, and fewer unpaid bills for hospitals that treat people who can’t pay.
Less outreach also means you won’t hear as much about open enrollment as you are used to. Even if you fully intend to sign up at Healthcare.gov, it sometimes takes a commercial, flyer or postcard to prompt you to actually sit down and go through the process. Combined with the shorter enrollment period, the lack of outreach makes it easier to miss the deadline. Set a day on your calendar, the earlier the better, to remind yourself to enroll at Healthcare.gov.
Value of Plans
The administration also changed the way it values health plans. The insurance marketplace requires plans be broken down by levels that reflect how much of a person’s healthcare costs it will cover, on average. Each level is represented by a metallic color: bronze, silver, gold and platinum.
There is a certain amount of flexibility built into what qualifies a plan for each level. To help insurance companies, the Trump administration gave them even more flexibility. Under the ACA, a silver plan, the plan on which the ACA subsidies are based, has to cover about 70 percent of healthcare costs on average. That figure is allowed to be off by 2 percent. Under the Trump administration’s new rule, they are allowed to be off by 4 percent. So a plan that is supposed to cover 70 percent of costs may actually cover just 66 percent.
The rates are calculated as an average of everyone enrolled in a plan, so you will not see a line in your paperwork saying how coverage is being lowered, but you may see it in higher deductibles or co-payments or a cut in services your plan covers.
Things to Remember
With the ongoing debate, uncertainty may be weighing on your mind as you consider whether to enroll. Here are some things to consider going into open enrollment:
- Health coverage is important. As someone who either has or had breast cancer, you have been in a situation where you needed expensive treatments and tests over the course of months or years. Even with insurance coverage you may have found your finances stretched to the breaking point. Getting coverage can help you focus on making decisions based on your health, not based on your checking account.
- The ACA is likely to remain in effect throughout 2018. Congress may, and probably will, try to reform healthcare again in the next year. While they can technically change the system immediately, Congress is not likely to end or change your enrollment or your assistance in the middle of the year.
- Healthcare.gov is full of resources. Visit the website whenever you have a moment and find answers to frequently asked questions, a guide about what documents and information you will need to enroll, and other guidance you may want before choosing a plan. You can also call (800) 318-2596 with any questions you may have about the process.