It’s that time of year again: in most states, the Affordable Care ActThe annual open enrollment season for health plans begins November 1 and lasts until January 15.
Current enrollees who do not update their information or select an alternative will be automatically re-enrolled in their current plan or, if that plan is no longer available, in a plan with similar coverage.
Last year marked a record registration of around 21 million people. This time around, consumers will find that some things have changed.
Don’t fall for advertising scams
Although some health plans offer small-value gift cards or other incentives to encourage participation in wellness efforts, they do not offer charge cards worth thousands of dollars per month to help pay for groceries, gas or rent. However, social networks and online sites are full of such promises.
Such advertisements are among the means allegedly used by unscrupulous brokers who sign up or switch plans without consumers’ express permission, according to a lawsuit filed in Florida.
Also be careful about the websites you use to search for coverage.
Type “Obamacare” or “cheap health insurance” into a search engine and often what comes up first are privately sponsored websites, not affiliated with official state or federal marketplaces for coverage. ACA.
Although they may try to appear official, this is not the case. Many such sites offer a variety of options, including non-ACA coverage with limited benefits, according to a 2023 study of “secret shoppers.” Such non-ACA coverage would not qualify for federal subsidies to help consumers to pay the premiums.
The fine print on some websites states that consumers who provide personal information automatically consent to being contacted by sales agents via phone calls, emails, text messages, or automated systems with prerecorded messages.
When exploring plans, always start with the official federal marketplace website, Healthcare.gov.
Even if you don’t live in one of the 29 states served by the federal marketplace, its website provides the link to your official registration site when you select your state, or the District of Columbia, from a drop-down list. Federal and state marketplaces also have call centers and other ways to get registration assistance. The “Find Local Help” link on Healthcare.gov, for example, gives consumers the choice of finding assistants or sales reps near them.
Is this real insurance?
Another concern: Regulators are seeing an increase in consumer complaints about health coverage offerings that require consumers to join a limited liability company or certify that they work for a specific company. Indeed, at least two states – Maryland and Maine – have issued warnings, saying that instead of comprehensive ACA coverage, it is often non-ACA products, amounting to, for example, a mix of credit cards. reduction or limited compensation plans. This type of plan pays a lump sum — say $50 for a doctor’s visit or $1,000 for a hospital stay — and is intended to augment more comprehensive coverage, not replace it.
“Unlike major medical plans, some of these self-funded plans only cover preventive services such as an annual exam or annual health exam,” the Maine Bureau of Insurance warning states.
Bonuses could be higher – and other new features
Some insurers will reduce their premium rates by 2025, but many others will increase them.
Although final numbers are still being analyzed, experts estimate a median premium increase of 7 percent, according to an analysis by KFF, a nonprofit health information organization that includes KFF Health News. Most people who purchase ACA coverage qualify for a subsidy to help them pay premiums, which is likely to offset much of the increase, although the higher cost means the government will pay more for these subsidies.
Rising healthcare costs — including for hospital care and the new class of weight-loss drugs — contribute to this increase.
Some other changes during this open season:
- People often referred to as “Dreamers” because they qualify for Deferred Action for Childhood Arrivals – a federal program providing some protection to people brought to the country as children without proper immigration documents – can enroll now for ACA coverage and are eligible for subsidies.
- Short-term plans, which are not technically ACA coverage and are not subject to its benefit rules and pre-existing protections, can be issued for, at most, only four months of coverage, based on ‘a measure of the Biden administration which came into force with the plans from September. 1. It rolls back a Trump administration rule that relaxed requirements allowing insurers to offer coverage for up to 364 days, and gave insurers the option to renew policies for up to two additional years . Existing plans and those issued before September 1 are not subject to the new rules. But consumers who were counting on longer periods should check their plan details and consider enrolling in an ACA plan to avoid a situation in which their short-term plan expires early or mid-year, potentially leaving them unable to get coverage elsewhere for the rest. of the year.
The registration process may also take longer
Federal regulators have been grappling this year with a growing number of complaints — 200,000 in the first six months alone — from consumers who were enrolled in or left ACA plans without their express permission by agents seeking to earn commissions.
To thwart these efforts, they implemented new rules.
What does this mean for most consumers? If you are working with a new agent – one who was not already on your ACA plan – you will likely need to make a three-way call with the federal marketplace to confirm that you are indeed authorizing that agent to make changes to your policy for the year to come. Expect this to take longer. No one knows how busy the call lines will be during open registration.
You do not need to use a broker to sign up. But sorting through the dozens of options available on the market is a challenge, which is why most people seek help. Consumers must weigh not only the monthly premium cost, but also changes in deductibles and co-pays for items such as doctor visits, hospitalizations and medications.
Compare prices
Experts say another consideration when choosing a plan is to check whether its network includes the doctors and hospitals you usually see, as well as whether its formulary covers your prescription drugs and how much it charges for them.
To make comparisons easier, rules that took effect two years ago require insurers to include certain “standardized plans” as options, all of which must have the same deductibles and costs for things such as doctor visits, emergency room care and other cost sharing for consumers. .
Despite this, many people have dozens of options, which can be intimidating.
But one piece of advice remains constant: whether you’re signing up for the first time or have an existing plan, it’s always worth shopping around. Even if you don’t change your plan, you can make sure the one you have remains your best option.
In most states, consumers must enroll by December 15 for coverage that begins January 1. Watch out in Idaho, where open enrollment starts earlier, October 15, but also ends earlier, ending December 15. Jersey, New York, Rhode Island and the District of Columbia residents can register until January 31.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the major operating programs of KFF — the independent source for health policy research, polling and journalism.
