Category: Government Programs, Health Insurance

Open Enrollment 2016: What to Expect

The Open Enrollment Period for 2016 health insurance plans on healthcare.gov started Nov. 1 and runs through Jan. 31, 2016. This is a good  time to point out some of the changes and offer some advice as you shop for your 2016 health plans.

First, I recently tried out the improved shopping engine added to healthcare.gov. I found it simple to access and use, and it was easier than last year to sort health insurance plans by price, deductibles or other coverages. You can shop without answering a bunch of questions or even creating an account and see what plan fits your needs very quickly. That’s a good thing.

Second, if you purchased from healthcare.gov in the past, there are a few important changes. The federal agency that runs the marketplace* has adjusted what we wonks call the “AV Calculator” (Actuarial Value Calculator), and the  cost sharing you are likely to see in a silver plan versus gold or bronze plan has changed. I did a quick check of the five cheapest silver and gold plans in 2015 versus the new 2016 “adjusted value” versions**, and I found the following:

Silver: For a 40-year-old, the average premium in the five best value plans went up an average of 3.4% in 2016, but the average DEDUCTIBLE went up 41% (more than $1,100!). That’s the effect of the government’s new definition of “silver.” People often shop for Silver plans because  Advanced Tax Credits have their biggest impact at the second cheapest silver plan, sometimes called the “benchmark” plan. Buying up from there increases your premium payments.

Gold:  The average premium in the five least-expensive gold plans went up 13% (for a 40-year-old) in 2016. The deductibles in this group are 45% higher than they were a year ago. This also was caused by the government redefining gold plans.

Based on the information above, it is imperative that shoppers look very carefully not just at premium prices, but also at deductibles, co-payments, coinsurance rates and other out-of-pocket requirements before selecting a plan. Just using premiums as a guide could leave a purchaser who already has health issues badly exposed financially.

When you consider shopping during this Open Enrollment Period, consider using a licensed agent to assist you. Your premiums will be exactly the same, and while healthcare.gov LOOKS easy to navigate, selecting a health plan is not. There are many variables to consider, and changing plans during the year is very difficult. Qualified help is available and free, so why not take advantage of it?

This is especially important if your household income falls between 100 and 400%*** of the Federal Poverty Level ($11,770 and $47,080 for a single person), as your premiums and deductibles will be highly dependent on your income and plan selection. Make sure your uploaded income numbers reflect your income for 2016 accurately and you are able to document big swings from your 2015 income to make sure your federal assistance lasts all year long. Remember healthcare.gov will start with your 2014 tax return as a baseline.

Additionally, the combination of low income and purchase of a silver plan gives a purchaser access to Cost-Sharing Reductions (decreased deductibles, coinsurance and co-payments based on income). At income levels below 150% of the Federal Poverty Level (about $17,700 a year for a single person), cost-sharing reductions on silver plans can reduce a deductible dramatically, even to $0 if the proper plan is selected.

Finally, as you shop for plans during 2016 Open Enrollment, pay special attention to the “Find a Doctor” sections on each plan. Medical Provider Networks are getting narrower, and marketplace plans often provide fewer doctor and hospital choices than typical employer-based coverage, so make absolutely sure your preferred primary care doctor, OB/GYN, clinics, hospital and any specialists you may already be using are included in a plan’s network before you buy. Don’t assume that just because your doctor was in the network last year or “takes Blue Cross,” he’ll be part of the network for the plan you buy for next year. . Check for yourself.

Purchasing insurance on healthcare.gov can be a rewarding experience, if you go in with the right tools and information to make an educated choice. Happy Shopping!

* Center for Consumer Information & Insurance Oversight, part of the Centers for Medicare and Medicaid Services
** For ZIP code 70810
***138% to 400% of federal poverty line in a Medicaid expansion state

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