Higher rates and fewer choices await many who will buy their 2017 health insurance policies through the Obamacare exchanges beginning Nov. 1. So brace yourself, and read on.
Here are the key things you need to prepare for changes in the Affordable Care Act (ACA) at healthcare.gov or your state health insurance exchange.
1. Key dates for 2017 coverage
If you’re an American who gets health insurance through your employer (you’re among the lucky 60 percent), your boss should tell you about your workplace’s open enrollment period. However, for the 1 in 6 who buy their own medical insurance, these are the dates you need to know:
Nov. 1, 2016: Open Enrollment starts — first day you can enroll, re-enroll, or change a 2017 insurance plan through a health insurance marketplace. Coverage can start as soon as Jan. 1, 2017.
Dec. 15, 2016: The last day to enroll in or change plans for coverage to start Jan. 1, 2017.
Jan. 1, 2017: Coverage for the year starts for those who enroll or change plans by Dec. 15, 2016.
Jan. 31, 2017: Last day to enroll in or change a 2017 health plan. After this date, you can enroll or change plans only if you qualify for a Special Enrollment Period.
Special Enrollment is available mainly for people who experience major life events, including:
- Loss of employer-sponsored health insurance coverage
- Marriage or divorce
- Birth or adoption of a child
- Moving to a home in a new ZIP code or county
Some people can get free or low-cost health care through Medicaid or the Children’s Health Care Program (CHIP), which provide coverage to millions with limited incomes and disabilities, and have no enrollment period. See if you qualify at healthcare.gov.
Getting insurance is required by law for many people.
The penalty for noncompliance is the greater of 2.5 percent of your adjusted gross income, or $695 per adult and $347.50 per child in tax year 2016. The amount for a household is capped at $2,085. The fee called the “individual shared responsibility payment” on healthcare.gov will be the same in 2017 and beyond, with adjustments for inflation.
If you lack coverage for only part of the year, the fee is prorated. For example, an individual who goes without health insurance for three months will be assessed 25 percent of the fee.
Those who owe the fee this year will have it assessed as part of their income taxes. Exemptions are available in certain situations, such as if you were without health insurance less than three months or the cost of the cheapest plan in your area exceeds 8 percent of your income.
3. Where to get coverage
If you’re eligible for insurance under the Affordable Care Act, go to healthcare.gov beginning Nov. 1. If your state has its own exchange, healthcare.gov will steer you there.
You can also call 800-318-2596 (be prepared to be on hold awhile) and have a representative complete your application over the phone.
Local organizations may help with the application and enrollment process. You can go to this page at HealthCare.gov to search for options in your area.
4. How to shop for coverage
Whether you’re happy with your existing plan or not, the open enrollment period offers a good time for a health-plan checkup to make sure you’re not making a costly mistake. Maybe your circumstances changed, your income went up or down, your number of dependents changed, you moved, you anticipate needing more or less medical care, or you just want to see if you can save compared with 2016.
Here are the main points to consider:
- Category: When you compare marketplace insurance plans, they’re put into five categories based on how you and the plan can expect to share the costs of care. The are, from lowest to highest premiums: Bronze, Silver, Gold, Platinum and, for a few, Catastrophic. Generally, the lower the premium, the more you’ll pay when you go for health care. Plans in all categories provide free preventive care, and some offer selected free or discounted services before you meet your deductible, healthcare.gov notes.
- Premium: The amount your insurance company charges. Tax credits are available to lower your portion of monthly premiums through the Health Insurance Marketplace. If your income goes up or fewer people are insured in your household, the credit goes down. Sliding-scale subsidies are available for people earning from 100 percent up to 400 percent of the federal poverty level, which currently is $11,800 for a single person, $16,020 for a couple, or $24,300 for a family of four. Some states have expanded Medicaid to cover more people below 100 percent of that level.
- Deductible: The amount you must pay out of pocket before insurance coverage will kick in for nonpreventive care.
- Co-payments: A flat amount you pay for certain services or items, such as office visits or prescription drugs.
- Co-insurance: Similar to co-pays, coinsurance is the percentage of a health care bill that is your responsibility.
- Network: Most health insurance companies have a network of providers and facilities that participate with their health plans. Be sure your favorite doctors, hospitals and clinics are a part of a plan’s network. Otherwise, you could be on the hook for your entire medical bill.
5. Rates up, choices down in 2017
You might not be able to keep in 2017 the same health insurance plan you have this year. The premiums for whatever plan you buy likely will higher than for similar plans in 2016, analysts say.
Fewer insurance companies are participating in Obamacare because, they claim, they can’t make money covering all people signing up, many of whom are sicker than expected.
A preliminary look by the McKinsey Center for U.S. Health Reform indicates 31 states may have two or more insurance carriers in 2017, while five states may have only have one in each county.
Final pricing is still being worked out in some markets, but a preliminary look at 17 major cities by the Kaiser Family Foundation indicates the costs for the lowest and second-lowest Silver plans will increase faster in 2017 than they have in previous years.
Based on insurer rate requests, the cost of the both the lowest and the second-lowest silver plans in these cities will increase by a weighted average of 9 percent, the foundation said. A few will see lower prices.The changes for the lowest-cost Silver plan will range from a decrease of 14 percent in Providence, Rhode Island, to an increase of 27 percent in Nashville, Tennessee; the second-lowest will range from a decrease of 13 percent in Providence to a 25 percent increase in Nashville.
The two lowest-cost silver plans are significant because they are the most common plan choices in the marketplaces, and the second lowest-cost plan is the benchmark used to calculate the government premium subsidies, the Kaiser foundation says.
“We remain confident that the majority of marketplace consumers will be able to select a plan for less than $75 per month when open enrollment begins November 1,” Marjorie Connolly, a Health and Human Services department spokeswoman, told The New York Times. “Last year, the average monthly premium for people with marketplace coverage getting tax credits increased just $4.”
What’s your experience under Obamacare? Share with us in comments below or on our Facebook page.