Choosing the right health insurance plan can be a cumbersome process, and this year’s political back-and-forth over Obamacare has made it seem even more confusing.
For months, executive orders and congressional debates have swirled around the law, officially called the Affordable Care Act. President Donald Trump has declared the law “dead” — but it’s still in effect, and open enrollment for plans on the Obamacare exchange begins Nov. 1.
Most people in Illinois get health insurance through their employers or government programs like Medicare and Medicaid, but this year, more than 350,000 Illinois consumers enrolled in coverage through the Obamacare exchange.
Thinking of buying health coverage on the exchange? Here’s what you need to know:
Consumers will have less time to enroll in exchange plans this year.
Open enrollment runs from Nov. 1 to Dec. 15 — about six weeks shorter than last year because of a new rule from the Trump administration. The website where people can purchase coverage — www.healthcare.gov — will also be down for maintenance most Sundays during that time.
“We’re all humans and we usually wait until the last minute to make decisions,” said Stephani Becker, a senior policy specialist at the Sargent Shriver National Center on Poverty Law. “Now with this very shortened … open enrollment period there’s not as much time to wait and think about it. People need to get in early.”
Before Nov. 1, consumers can create accounts at healthcare.gov, if they don’t have them already. That may help speed the enrollment process.
Many consumers will still get tax credits and reduced co-pays and deductibles next year.
People can make up to 400 percent of the federal poverty level ($98,400 a year for a family of four in 2017) and get tax credits to help offset the cost of premiums. About 81 percent of Illinois residents on the exchange received the credits as of February of this year, according to the Henry J. Kaiser Family Foundation. Trump’s recent executive order involving the Affordable Care Act does not affect those tax credits.
Consumers below certain income levels will also still benefit from cost-sharing reductions — reduced deductibles, copayments and coinsurance — if they choose silver-level plans. Trump recently announced the government would no longer give insurance companies money to help offset those reductions to consumers, but insurers must continue to offer those reductions to consumers, regardless of whether they get those federal dollars.
Illinois consumers will have fewer choices of insurers and some will face higher premiums.
This year, seven Illinois counties had only one insurer offering plans on the exchange. Next year, that number will rise to 13 counties. Counties limited to one choice of insurer will include Lake, McHenry and DeKalb as well as a number in the northwest corner of the state and southern Illinois.
Premiums are rising. Average rates are set to increase by 16 to 37 percent next year for the lowest-priced plans, according to the Illinois Department of Insurance. People who get tax credits likely won’t feel the effects of those rate hikes because the amounts of their tax credits will rise with the higher premiums.
“People who don’t get a subsidy, they’re the people that are harmed the most,” said insurance broker Robert Slayton, past president of the Illinois State Association of Health Underwriters.
Some consumers should consider buying plans outside the exchange.
People who make too much money to qualify for tax credits might want to explore options outside the exchange. People can also buy plans outside the exchange, through insurance brokers or directly from insurance companies.
Trump recently issued another executive order that would allow consumers to buy short-term insurance plans for longer periods of time and let small businesses band together to offer so-called association health plans. Such plans might be cheaper — and cover less — than exchange coverage.
But that executive order has not yet been put into effect. Slayton recommends people buy insurance coverage soon, and not wait until the order goes into effect.
“I would absolutely, positively not recommend people wait,” Slayton said. “My suggestion for people is sign up for something. If something new comes out, you can always cancel your coverage.”
It’s important to actively shop for a plan.
Consumers who have exchange coverage can, in theory, sit back and still have coverage for next year. Even if they don’t shop, they will be automatically re-enrolled in their current plans or similar plans. This year, nearly 18 percent of Illinois residents with exchange coverage were automatically re-enrolled, according to the federal Centers for Medicare & Medicaid Services.
But that might not be the best idea, said Inna Rubin, manager of health access initiatives at the United Way of Metro Chicago.
Insurers, including Blue Cross and Blue Shield of Illinois, are changing many of their plan offerings on the exchange for next year. As a result, if people choose to auto-enroll, they may find themselves with a plan that doesn’t cover all their doctors, covers drugs differently or costs more, Rubin said. Also, if people’s incomes have changed since last year, that could change the amount of the tax credits they qualify for, she said.
Plus, for some shoppers, gold-level plans might actually be better deals than silver-level plans because of the way Illinois instructed insurers to handle price increases due to uncertainty over the cost-sharing reductions, Becker said.
When shopping, Slayton recommends consumers start by finding plans that include their preferred hospitals and doctors.
Help is available.
A number of organizations offer trained people, called navigators, who can help guide consumers through the process.
The United Way of Metro Chicago, for example, oversees about half of the navigator program in Chicago. People can call and ask questions or visit in person for help enrolling. Consumers can make free appointments online at www.getcovered.illinois.gov, www.liveunitedchicago.org/getcovered or www.ilcha.org/help to see navigators across the state.