BEYOND THE NUMBERS
This Saturday, December 15, is the last day to buy a health plan for 2019 through HealthCare.gov, and everyone who either has coverage through the Affordable Care Act’s marketplace or who’s uninsured should go to the marketplace before the deadline.
Why should current enrollees return to the marketplace?
- Circumstances change. Even those who want to keep their current plan in 2019 should return to the marketplace and update their income, household size, and other information to ensure they receive the proper amount of financial help in 2019. Circumstances change from year to year, and information that a person projected a year ago may no longer be correct.
- New health plan options are available. Even if a person’s current plan is available for 2019, premiums, provider networks, and deductibles or other out-of-pocket charges usually change from year to year. HealthCare.gov offers lots of plan options for 2019 – on average, marketplace shoppers will have 26 different plans to choose from in 2019, the Department of Health and Human Services (HHS) estimates. Marketplace premiums fell slightly overall for 2019, and people eligible for subsidies may be able to find a plan with premiums covered entirely by tax credits. This makes it even more important for people to return to the marketplace, assess the available plan options in 2019, and make sure they’re enrolling in a plan that best suits their needs.
- Switching plans outside of open enrollment is restricted. Once open enrollment ends, marketplace enrollees can only switch plans if they’re eligible for a special enrollment period (SEP) based on a limited set of qualifying events, such as getting married or moving. Plus, not all plans are available in such situations. That’s why people should make sure to enroll in the plan that best suits their needs during open enrollment, when they can choose from a full array of plan options.
Why should people who are new to the marketplace consider enrolling?
- Marketplace plans protect against catastrophic costs and offer comprehensive, essential health care services. All marketplace plans must provide comprehensive coverage, which includes a required set of covered benefits, preventive services at no cost, protections for people with pre-existing conditions, and safeguards against high out-of-pocket spending. But marketplace plans are only available to buy during open enrollment (or an SEP, for those who qualify). For people who need health coverage, missing the December 15 deadline likely means waiting until 2020.
- Many people are eligible to receive financial help that lowers premiums and out-of-pocket costs. Most current and potential marketplace enrollees are eligible for federal premium tax credits, which make premiums more affordable and protect enrollees from rising premiums because they rise when premiums rise. In fact, 79 percent of people shopping for coverage on HealthCare.gov can find a 2019 plan with a premium under $75 per month after accounting for tax credits, according to HHS. Some uninsured people who are eligible for a credit may not even know it: an estimated 7.5 million of the 30 million uninsured are eligible, the Urban Institute found. (Another 7.5 million are eligible for Medicaid but aren’t enrolled.) In addition, moderate-income people are eligible for plans with lower deductibles and co-pays. More than half of marketplace enrollees benefited from these cost-sharing reductions in 2018.
With less than one week left to buy a health plan for 2019, now is the time to return to the marketplace and shop for coverage – whether you’re a new or returning enrollee.