BEYOND THE NUMBERS
Starting today, people can sign up for 2019 health coverage through the Affordable Care Act (ACA) marketplaces in most states. Despite Trump Administration actions that have raised premiums and threaten to depress enrollment, the marketplaces have proven resilient, and surveys show that the large majority of marketplace consumers are satisfied with their coverage. Both new and returning customers have plenty of reasons to visit HealthCare.gov or their state-based marketplace before open enrollment ends:
- Many people are eligible for financial help. The large majority of current and potential marketplace enrollees are eligible for federal premium tax credits, which help them afford their premiums and protect them from premium increases by rising when premiums rise. Fully 87 percent of marketplace enrollees in 2018 qualified. Some uninsured people are eligible for a credit but may not know it: an estimated 7.5 million of the 30 million uninsured are eligible for a credit because they meet the income requirements, the Urban Institute found.
Some 79 percent of HealthCare.gov consumers can find a 2019 plan with a premium under $75 per month after tax credits, according to the Department of Health and Human Services (HHS). In addition, many people are eligible for cost-sharing reductions, which lower their out-of-pocket costs for health care.
- Marketplace plans provide comprehensive health insurance. Health plans available on the ACA marketplaces can’t deny coverage or charge higher prices to people with pre-existing health conditions. They also must cover a comprehensive set of “essential health benefits” (such as prescriptions and doctor visits, maternity care, and mental health treatment), and all enrollees get preventive benefits (such as annual checkups) at no cost. Plus, they provide financial protection against catastrophic medical costs due to illness or injury. Some plans that will be sold outside of the marketplaces during open enrollment, such as short-term plans, lack many of these critical features.
- People can find affordable premiums and deductibles in 2019, just as they did in 2018. In 2018, for complicated reasons related to Trump Administration actions, the lowest-premium gold plan cost less than the lowest-premium silver plan in nearly 500 counties nationwide — even though gold plans generally have lower deductibles and other cost sharing. Also in 2018, more than half of people who were uninsured and eligible for marketplace coverage could have enrolled in a bronze plan and paid zero net premium (that is, a premium after accounting for premium tax credits). For 2019, people eligible for premium tax credits can find similarly good deals for gold and bronze plans. In addition, unsubsidized consumers may find gold plans that cost about the same as, or less than, silver plans, so they can save money on premiums and lower their deductible by switching from silver to gold.
- Plan options have grown in many areas. Some insurers are entering the marketplaces for the first time this open enrollment season, others that left in 2016 and 2017 are returning, and insurers already in the marketplaces are serving more areas. Twenty-three more insurers will offer plans in 2019 than in 2018, HHS estimates. That will give some consumers more plan choices, which could help them find a plan with features (such as a provider network and deductible level) that meet their needs.
As in past years, new and returning customers should go to HealthCare.gov or their state-run marketplace and assess their options to make sure they enroll in a plan that best meets their needs. Even those who liked their plan in 2018 may find an option with a lower deductible or premium, or better coverage for the services they need. Plus, all returning consumers should update their income and other information so they receive the correct amount of financial help based on their current situation.
Open enrollment ends on December 15 in all states that use HealthCare.gov. Trained, certified consumer assistance groups are available in many places for consumers who want help understanding plan options and applying; the Get Covered Connector website has details.