What you need to know for the 2017 Obamacare open enrollment

Staff at the Access Health CT enrollment center in New Britain preparing for the open enrollment that ended in January.

CTMirror.org File Photo

Staff at the Access Health CT enrollment center in New Britain preparing for open enrollment last year.

If you buy health insurance on your own, or plan to, your chance to sign up for 2017 coverage starts next week. This year’s open enrollment period is coming after several months of turmoil for the state’s health insurance exchange, including the departure of two insurance companies, big price hikes and a major change in the availability of insurance agents and brokers who have helped many people pick health plans in the past.

Here’s what you need to know about the open enrollment period, in two parts: What’s new this year and, for those new to the process, the basics on buying insurance.

Part 1: What’s new this year?
What are the dates and deadlines?

Insurance enrollment deadlines
Sign up by… For coverage beginning…
Dec. 15 Jan. 1
Jan. 15 Feb. 1
Jan. 31 March. 1

Open enrollment will run from Nov. 1 through Jan. 31. If you want a plan that takes effect Jan. 1, you’ll need to sign up by Dec. 15. The deadline for coverage that starts Feb. 1 is Jan. 15. If you sign up between Jan. 15 and Jan. 31, your coverage will begin March 1.

If you qualify for Medicaid, you can sign up at any time during the year.

I’ve been hearing about rate hikes. Will I be paying a lot more?

The price of health plans sold through Connecticut’s individual market is slated to rise by an average of 24.8 percent, according to the Connecticut Insurance Department. But what that means for your monthly premium will vary based on several factors – most importantly, whether you get a discount on your coverage through Obamacare.

If you don’t, your price hike will depend on your age, county and the specific plan you choose. And yes, you’re likely to see a sizable increase if you keep the same level of coverage.

Here are two examples of price changes, based on unsubsidized standard plans sold through the state’s health insurance exchange, Access Health CT:

  • A 30-year-old Hartford County resident who buys the ConnectiCare standard bronze plan would face a monthly premium hike from $215 this year to $261. The deductible on this plan – money the customer must pay out-of-pocket when getting medical care – is also rising, from $5,500 to $6,000 (for family coverage, it’s rising from $11,000 to $12,000).
  • A 50-year-old in New Haven County who buys Anthem’s standard gold plan would see the monthly price rise from $518 this year to $594. The deductible is increasing from $1,000 to $1,550 (or from $2,000 to $3,100 for family coverage).

But price hikes are likely to be at least partially offset for people who get discounts on their premiums through the federal health law. Technically, those discounts are tax credits from the federal government, and they’re only available to people who buy their insurance through the exchange. About three-quarters of Access Health customers get these discounts.

The discounts are designed to keep people from paying more than a certain percentage of their income for a midlevel plan. That means that higher premiums from one year to the next will lead to higher levels of subsidies.

As a result, customers getting discounts will most likely see a smaller increase than the change in sticker price for their plans – or no change at all. Customers getting discounted coverage could also minimize any increase by picking a cheaper plan within the same coverage level, making their subsidy go further.

What else is changing?

There will be fewer insurance companies selling plans through the state’s individual market. UnitedHealthcare is exiting the market, and HealthyCT will no longer sell coverage. That means people with plans from those companies will need to pick something else for 2017.

connecticare-store-door-open

Arielle Levin Becker / CTMirror.org

The ConnectiCare store in Manchester.

Exchange customers will have a choice between two companies: Anthem Blue Cross and Blue Shield, and ConnectiCare Benefits. People who buy outside the exchange will have five options: Aetna, Anthem, Cigna, ConnectiCare, and Golden Rule.

For exchange customers, there also will be fewer choices of plans – 19 in 2017, down from 40 this year. That’s mostly because there are fewer companies, but ConnectiCare Benefits also is offering fewer options than it currently does. In particular, the company is eliminating its platinum plan, which, compared to other plans, had high premium costs but low out-of-pocket costs for people when they got care. As a result, there won’t be any platinum plans on the exchange in 2017.

Where can I get help picking a plan?
The Access Health CT storefront in New Britain shortly after 10 a.m. Most of those in the waiting area were exchange staff.

Arielle Levin Becker / CTMirror.org

The Access Health CT storefront in New Britain.

Access Health will have brokers available through its call center (1-855-805-4325) and at its storefronts in New Haven (55 Church St.) and New Britain (200 Main St.). To find in-person help near you, click here.

If you plan to buy a plan outside the exchange, insurance agents and brokers are available to help. You can find an agent or broker by clicking here. (In the past, many exchange customers relied on agents and brokers in the community, but they will no longer receive commissions for plans sold through the exchange, so their availability to help exchange customers is likely to be limited.)

If you are a ConnectiCare customer, you can also get help at the company’s store at 1487 Pleasant Valley Road in Manchester.

What happens if I don’t have coverage?

If you don’t have health care coverage in 2017, you’ll have to pay a fee when you file your taxes in 2018. The penalty is either 2.5 percent of your household income or $695 per person (or half that, $347.50 for each child) – whichever is higher.

If you have coverage for part of the year but are uninsured for other parts, you’ll face a prorated fee, based on the number of months you went without coverage.

There are exceptions, though. People can be exempt from the penalty for a variety of reasons, including not making enough money to file taxes or being uninsured for fewer than three consecutive months during the year. You can find more information on exemptions here.

Part 2: I’m new to this. What should I know?
Where do I buy insurance?

If you need to buy insurance on your own (that is, if you don’t get it through a job or your parents’ plan, and if you don’t qualify for Medicare or Medicaid), you can buy coverage through the state’s individual market. There are two main sources of individual market coverage: the exchange and outside the exchange.

Why pick one over the other? You can check your options for both, but there are some key differences:

Depending on your income, you might qualify for discounted coverage through Obamacare. If so, you can only get that discount if you buy your insurance through the exchange. (The income limit is 400 percent of the poverty level – the cutoffs are listed in the chart below. The discounts are actually tax credits, paid either in advance to your insurance company or to you when you file your taxes in 2018.)

Income limits for Obamacare subsidies
People earning below these levels can qualify for federal tax credits to subsidize their insurance premiums if they buy coverage through the exchange.
Family size Income limit for subsidies
1 $47,520
2 $64,080
3 $80,640
4 $97,200
5 $113,760
6 $130,320
7 $146,920
8 $163,560

On the other hand, you will find more choices of plans outside the exchange, since more insurance companies sell policies to individuals through the off-exchange market. In addition, some off-exchange plans have larger networks of health care providers, meaning that you might have a wider choice of doctors and other providers if you buy an off-exchange plan.

Ok, so how do I actually sign up?

You can view your choices for exchange plans at www.accesshealthct.com. You can use that site to see if you qualify for discounted coverage and view the various options. You can also use the exchange’s call center at 1-855-805-4325. There are also several locations statewide you can go to for help signing up, including the storefronts.

If you’re planning to buy insurance outside the exchange, you can buy through the companies directly, through online shopping sites, or through an insurance agent or broker. To find an agent or broker, click here.

The different options are called gold, silver and bronze. What’s the difference between them?
Eva Bermudez, an organizer with the union CSEA, helped Maxime Calixte sign up for health insurance last year.

Arielle Levin Becker / The CT Mirror

Eva Bermudez, an organizer with the union CSEA, helped Maxime Calixte sign up for health insurance during the first open enrollment period in late 2013.

Health plans are identified by metal tiers – that is, bronze, silver, gold and platinum.

In general, they vary based on premium and how much coverage you get for the money.

Bronze plans typically have the lowest premiums (the monthly payment you make, regardless of whether you use coverage). But they require members to pay the most when they get care. The standard bronze plan sold through the exchange, for example, will have a $6,000 deductible for individuals (or $12,000 for family coverage), meaning that members would have to pay $6,000 toward medical care they get before the plan begins picking up part of the tab. (There are exceptions for certain preventive services that plans must cover at no charge to members.)

By contrast, gold plans have some of the highest premiums, but members pay less when they get care. The standard gold plans sold through the exchange have a $1,550 deductible for individuals ($3,100 for families), but for many health care services, members only have to pay a fixed copay (such as $20 or $40) and the plan will pay the rest.

Platinum plans have even higher premiums and lower out-of-pocket costs than gold plans, but there aren’t any being sold through Connecticut’s exchange for 2017.

People under 30 can buy catastrophic plans, which have lower premiums but require the highest spending when people get care.

What else do I need to know before buying insurance?
The FH Cost app

The FH Cost app

Experts say you should always be sure to check whether any health care provider you plan to see takes the plan you’re considering. You can check that on the provider listing from the insurance company. You can also call your doctor’s office and ask if they take the plan; be sure to specify which plan offered by that company, since some providers take only some of a company’s plans (for example, they might take the off-exchange plans but not those sold on the exchange).

If you take medications, you should also check how those would be covered under each plan you’re considering, since the cost to you could vary considerably.

And you’ll want to make sure you understand how the plan works – that is, what you’d likely have to pay for getting care. Aside from agents and brokers, who can advise you on picking plans, there are some tools available to help estimate the costs you might face when getting care.

FH Cost Lookup CT is a free mobile app from FAIR Health, a national nonprofit that tracks health care prices. The app can help estimate the cost of medical and dental services in Connecticut. It also has a list of Connecticut-specific resources, a glossary of health care terms and medical and dental procedures, and a section on the basics of health insurance. The content is available in English and Spanish. It can be downloaded from the iTunes App Store and Google Play.

Access Health also has a tool designed to help you understand the costs you’d likely face in each plan, based on your medical needs.

The Connecticut Insurance Department publishes information on insurance companies through its annual consumer report card. The most recent one was released this week, and it has a worksheet for comparing insurance plan options on the last page.

For more details on experts’ advice on picking a plan, click here.

Comments

comments