Obamacare’s sixth open enrollment begins Thursday, with a slew of new regulations and changes for customers to navigate as they shop for health plans.
The healthcare law, formally known as the Affordable Care Act, over the years has faced website problems, regulation alterations, price hikes, and legal changes. It remains politically loaded, but is still the law of the land. Customers will still be able to buy coverage regardless of whether they are sick.
Here are the seven things customers should know about open enrollment, the period when people can shop for health insurance plans on healthcare.gov or on state websites, both of which are known as “exchanges.” The rules apply to people in the U.S. who do not receive health insurance through a government program or work.
1. People won’t be fined if they go uninsured
The Republican-backed tax bill that President Trump signed into law zeroes out the fine for going uninsured, known as the “individual mandate.”
This means that if people choose not to buy health insurance that goes into effect in 2019, then they won’t be fined. The fine used to be 2.5 percent of income or $695 for an individual, whichever was higher.
People will still pay the penalty if they were in uninsured in 2018, though it contains multiple exemptions.
State Exceptions: The District of Columbia, New Jersey, and Massachusetts have their own fines, and Vermont’s individual mandate will go into effect beginning in 2020.
2. People can buy plans outside of Obamacare’s rules
Certain people who buy Obamacare plans are looking at daunting rate increases that may have caused them to be priced out of the market. With an eye toward helping those people, the Trump administration extended what are known as “short-term plans.”
Up until 2016, people could be covered by these plans for up to a year, then the Obama administration shrunk them to only three months so that more people would go into Obamacare instead. The Trump administration reinstated the one-year policy, and allowed customers to renew the short-term plans twice, for a total of three years. People have been allowed to buy these plans since Oct. 1, and they can be bought year-round.
Short-term plans are not sold on the exchanges, and can be less expensive than Obamacare plans. They are not obligated to cover a specific range of medical services, such as maternity care, prescription drugs, or mental health treatment, and they don’t have to be sold to people with pre-existing conditions, such as diabetes.
“If you have a chronic health issue or pre-existing condition then the ACA plan will be in your best interest,” said Shaun Greene, senior vice president at AgileHealthInsurance.com, which offers plans outside the Obamacare market.
He said it was important for people to read their plans and understand their limitations and exclusions.
Kelley Turek, executive director of employer and commercial policy at America’s Health Insurance Plans, echoed similar advice.
“Understand your options and get educated,” she said. “Really think about your health needs and your financial situation.”
State Exceptions: California, Massachusetts, New York, New Jersey, Rhode Island, and Vermont don’t allow short-term plans. Other states limit them to six or three months, according to Healthinsurance.org.
3. Don’t expect many commercials or navigators
The Trump administration will be spending $10 million on advertising open enrollment, as it did in 2017. This is a cut from the $100 million the Obama administration spent in 2016.
It also cut funds for “navigators,” which are people who receive grants from the federal government to help customers sign up for coverage. The navigators received $10 million this year, a drop from the $36 million they received the year before and from the $100 million they received under the Obama administration.
The Trump administration has said that its spending on advertising is cost-efficient and effective, and said navigators weren’t helping enough people enroll.
Turek said that health insurers were doing their own outreach locally, through marketing and events.
One group called Get America Covered, co-founded by Obama-era officials, is bolstering efforts to get the word out through social media. The group would not disclose how much it was spending on its campaign.
“Get America Covered is returning for a second year because the administration is once again not doing their job,” said Joshua Peck, the group’s co-founder. “People need the facts. So that’s what we’re going to do, make sure that people have the basic information they need to sign up for coverage.”
4. Open enrollment is six weeks for most states
Open enrollment begins Nov. 1 and runs until Dec. 15 for most states. People who do not select a healthcare plan by that deadline will be automatically re-enrolled into their former plan or into one that is similar.
The Trump administration shortened the open enrollment period during 2017, its first year managing the website, from when the Obama administration oversaw it and it lasted three months. The Obama administration had planned for a similar shortened time period of six weeks to take effect beginning this year.
State Exceptions: Open enrollments are longer in California, Colorado, New York, Massachusetts, Minnesota, Rhode Island, and the District of Columbia.
5. Premiums will drop slightly, and people will have more options
Premiums in the Obamacare market are set to drop for the first time, by an average by 1.5 percent.
That figure applies to rates on silver plans, which are the midlevel plans offered. In dollar amounts, they are expected to cost an average of $406 a month, a total that does not include out-of-pocket expenses, such as deductibles.
The decline in premiums comes after people faced average rate hikes of 34 percent in 2018. This jump occurred largely because insurers were unsure how the Trump administration would handle the law and as they waited to see how the “repeal and replace” efforts by Republicans in Congress shook out.
Insurers had also raised premiums to make up for Trump cutting off a government funding mechanism known as cost-sharing reduction subsidies. But cutting off the funds ended up giving more people the option to buy coverage at a very low premium, even $0 a month, because insurers raised prices on certain plans in a way that shifted more costs onto the federal government to make up the difference.
Ahead of this open enrollment, insurers say they understand the market better, including what types of people are most likely to sign up. The Trump administration helped lower rates in several states by approving federal funding known as reinsurance, a mechanism that pays for high medical expenses.
About 10 million customers get subsidies that blunt their premium costs. An additional 7 million customers, however, are unsubsidized, and many of them purchase their plans outside the exchanges, such as directly from an insurer.
What people pay for premiums will vary depending on how much they make. For 2019, people will generally get subsidies when their income is below about $48,560 a year for an individual and $100,400 for a family of four. Other factors at play in the cost include location, smoking status, and age.
For customers on the exchanges there will be more options to choose from. Twenty-three more insurers will be entering the exchanges and 29 will be expanding. This past year, 56 percent of counties had only one insurer offering coverage, but that number has dropped to 39 percent for 2019.
6. Healthcare.gov will go offline for maintenance
The Trump administration is expecting to take down healthcare.gov for maintenance for several hours nearly every Sunday during open enrollment.
The website will go offline for 12 hours, from midnight until noon, every Sunday except Dec. 9, 2018, and may also be taken down during the early morning on the first day of open enrollment while programmers make final adjustments.
The total downtime is expected to be no more than 60 hours, but a spokesman from the Centers for Medicare and Medicaid Services said it is likely to be far fewer. Last year, the site was down for only 21.5 hours, even though the same 60-hour windows were planned.
7. It’s not clear how many people will sign up
The Trump administration hasn’t provided estimates for how many people would sign up, but it will be releasing enrollment numbers every week. Last year 11.8 million people signed up through the exchanges by the end of open enrollment, but a certain portion tend to drop out, whether because they fall behind on their premiums or find a job that gives them coverage.
Deep Banerjee, a health insurance expert and director at S&P Global Ratings, said he thought the number of people who end up paying premiums for a full year on the exchanges would settle right around 9 million, even without the individual mandate and the ability to buy plans outside Obamacare’s rules.
“Those left on the exchange are subsidized and are signed up because they need the more comprehensive health insurance plans,” he said.
