If you buy health insurance on your own, rather than through an employer, picking a policy for 2018 is going to be more complicated than usual.
Prices are going up for some people, coming down for others. Many areas have lost plans; some have gained new ones. And you don’t have a lot of time to sort out your options. This year’s open enrollment period is shorter than in the past. In most states it will end on Dec. 15, after just six weeks.
All the information you need is out there, along with people who can decipher it and guide you through the enrollment process. But it helps to know where to look and, particularly this year, it may help to look in more than one place.
Here are some of the resources and people you can consult:
HealthCare.gov And Its State-run Marketplace Counterparts
You probably know about HealthCare.gov and CuidadoDeSalud.gov ― the one-stop-shopping, federally run websites that, in 38 states, individuals use to find health insurance policies and enroll in them. The exceptions are California, Colorado, Connecticut, Idaho, Maryland, Massachusetts, Minnesota, New Mexico, New York, Rhode Island, Vermont and Washington. They have their own websites, as does the District of Columbia.
These sites will let you know quickly whether you are eligible for tax credits that could discount your premiums by hundreds or even thousands of dollars, and in some cases wipe out premiums altogether. They will also let you know all about the policies you can buy with those tax credits ― providing information not just on premiums, but also on out-of-pocket expenses, doctor and hospital networks, and formularies for prescription drugs. (Formularies are lists of drugs that insurance companies will or won’t cover, along with whatever co-payments you’ll need to pay to get them.)
In the past, information about networks and formularies hasn’t always been totally accurate or up to date. That’s a big deal. You don’t want to get a policy thinking it will pay for visits with a longtime doctor or cover a prescription you use regularly, only to discover too late that it won’t. If there’s a provider or drug of particular importance to you, double-check with insurers, providers and drugstores to confirm any information from the websites.
The websites also have glossaries to explain key concepts, such as the difference between a deductible and an out-of-pocket maximum. If you need more help ― or if you just prefer to deal with a person rather than a website ― the sites all have call centers with trained professionals who can answer questions and sign you up directly.
The number for HealthCare.gov is 1-800-318-2596. In the 12 states plus the District of Columbia that don’t use HealthCare.gov, the phone numbers for their call centers are on their state websites.
Note that HealthCare.gov will be down for maintenance on almost every Sunday during open enrollment ― for up to 12 hours, 12 a.m. to 12 p.m. Eastern, each time. Trump administration officials say this is normal. Officials who worked at the Department of Health and Human Services during the Obama administration say this is a lot more planned maintenance than the system has needed previously.
Online Brokers And Insurer Websites
This year, for the first time, you can go through the entire application process through one of several websites that HHS has designated a “direct enrollment partner.”
Five of the partners are online brokers that look and operate a lot like HealthCare.gov. You can even get the law's tax credits through them.
One of the partner sites, Health Sherpa, offers only the plans that are available on government websites. The other four ― eHealth, GetInsured, GoHealth and Stride Health ― also offer “off-exchange” plans.
Off-exchange policies are plans that insurers don’t sell through the government sites and for which you can’t use the law’s tax credits. They provide consumers with extra options, but you need to be careful when you consider them.
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If your income is too high to qualify for that financial assistance, because your income is more than four times the poverty line ($48,240 a year for an individual and $98,400 a year for a family of four), you might discover off-exchange plans cheaper than comparable plans available through the government websites. It depends on your individual financial circumstances and the plans available where you live.
The catch is that some of these off-exchange plans do not live up to the Affordable Care Act’s requirements. They may not cover all 10 “essential benefits,” for example, and they might not be available to people with pre-existing conditions. They also might not satisfy the law’s individual mandate, which applies a financial penalty on people who could get affordable insurance but decline to get it.
An example would be “short-term insurance plans” which, in many cases, are available for only three months at a time and cannot be renewed afterward. They tend to cover less and, partly as a result, they tend to be cheaper.
You don’t have to worry about this at Stride Health. Even its off-exchange plans meet the Affordable Care Act’s standards, a company official said. But the other three partner sites with off-exchange plans all include some noncompliant policies. The websites should make clear which ones abide by the Affordable Care Act rules and which ones don’t.
Insurers also run their own websites, by the way. They tend to offer detailed information about their own plans but, naturally, they don’t offer information about their competitors. To date, HHS says it has approved eight insurer sites as direct enrollment partners ― meaning, again, you can actually complete an application and qualify for financial assistance on their websites.
Those insurer websites are Aspirus Arise Health Plan in Wisconsin; Blue Cross Blue Shield of Michigan; Centene, which offers plans in in several states; Dean Health Plan in Wisconsin; Horizon Blue Cross Blue Shield of New Jersey; Oscar Health, which operates in several states; and Security Health Plan of Wisconsin.
HHS says it will be approving more partner websites soon, perhaps before open enrollment ends on Dec. 15.
Navigators, Assisters And Counselors
If you want a human being to answer your questions, to teach you more about your options, and to help you enroll, you can turn to a variety of individuals and groups who have received special training ― and are officially authorized by the Affordable Care Act ― to do just that.
The law calls them “navigators,” “assisters” and “certified enrollment counselors.” They include everybody from people at nonprofit organizations whose sole purpose is Affordable Care Act outreach to social workers at community clinics who work with people on a number of different government programs. You can find the advisers in your area through HealthCare.gov ― use the “find local help” link ― or through one of the state websites.
The Trump administration has dramatically cut funding for navigators this year, so, especially with the shorter open enrollment period, their services may be in high demand. It makes sense to seek them out sooner rather than later.
By law, these counselors have no ties to insurers and receive no money from them.
Agents And Brokers
Agents and brokers have been advising people about insurance and selling policies for a long time ― and many of them have years of experience they can use to help you figure out which insurance option is best for you.
Agents sell policies from just one carrier or sometimes a few. Brokers typically sell from many. Both are subject to state licensing requirements.
The ones who can help you enroll in exchange plans directly must receive special certification from their states or the federal government. The ones you’ll find through the HealthCare.gov “local help” option have gone through that process.
Agents and brokers also operate on commission, which they get from the insurers, unless they work for just one carrier, in which case they might be paid on salary. That means you don’t have to pay them separately.
But remember: They may be telling you only about the plans they sell or that pay them commissions.
Other Sources Of Information
The Henry J. Kaiser Family Foundation has an exhaustive list of 300 questions ― and answers ― about open enrollment.
HealthInsurance.org has its own, thorough guide to open enrollment as well as detailed, independently reported information on what’s happening in each state. It also has an online form where you can get quotes from a local broker.