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Health insurance and open enrollment – what you need to know

“As open enrollment for health insurance begins Wednesday, Nov. 1, and several changes have occurred or been proposed, I decided to check in with two industry experts for their advice on what you need to know.

Kathy Lipscomb, health care advocacy consultant at KL Services, LLC in Skokie; and Michele Thornton, Health Insurance Consultant at Thornton Powell Insurance Financial Services in Oak Forest, identified for me some of the most critical issues and uncertainties currently surrounding the health insurance marketplace about which they feel consumers should be most aware.

Shortened enrollment period

For the first time, open enrollment via the health insurance marketplace (www.GetCovered.Illinois.gov, here in Illinois) will last only 45 days: Nov. 1 through Dec. 15. This is a significant change from previous years’ enrollment periods, which lasted three months, and almost always included an extension. There are few indications that an extension beyond Dec. 15 will be offered this year.

Employer insurance impacts

Some employers are enrolling employees in health insurance plans earlier and for shorter periods of time this year due to more complex federal rules and uncertainty surrounding future rate hikes. Be aware: Some employers are offering insurance to only those employees who cannot obtain coverage via a spouse’s plan.

Elimination of subsidies

The Department of Health and Human Services announced on Oct. 12 that cost sharing reduction (CSR) payments will be discontinued effective immediately. CSRs are federal government subsidies provided to insurers to reduce the amount low-income consumers pay for deductibles, copayments and coinsurance. A congressional bipartisan agreement was recently announced proposing these subsidies continue for two more years, but a vote has yet to be taken and its prospects for wider bipartisan support are uncertain. This uncertainty is anticipated to significantly increase premiums for plans offered via the exchange.

Navigator funding slashed

Funding for health care navigators – organizations funded by the federal government to assist consumers (free of charge) with finding and enrolling in health plans – has been cut by 90 percent. To compensate, the federal government is providing a tool that enables consumers to search for agents and brokers at www.healthcare.gov. Consumers can also search for a marketplace-certified broker by using the finder tool at www.NAHU.org (National Association of Health Underwriters).

Major changes to individual BCBS policies

One of Illinois’ largest individual insurance providers, Blue Cross and Blue Shield, is changing most of its plans. Customers impacted by these changes should have received notification that their policies are being eliminated for 2018. Eliminated plans have been “mapped” to new BCBS plans at the same metal/coverage level and within the same network, however premiums will likely be higher and coverage different. If details on these changes have not yet been received, consumers can find information at www.healthcare.gov (for marketplace customers), via their BCBS online accounts (for direct BCBS customers) or through their insurance brokers.

Marketplace plans available off the exchange

As of this writing, the GetCovered.Illinois.gov website had not yet been updated for 2018 enrollment. However, every health plan offered on the exchange must also by law be offered off the exchange at the exact same price, so research can – and should – begin now. With a shortened 45-day enrollment period, agents, brokers and the few remaining navigators will be in high demand once enrollment opens.

Other non-exchange-based, insurance options

The exchanges are not the only way to obtain health insurance. Other options include through an employer, directly with a specific insurance provider, through an insurance broker (be aware some sell only specific insurance company products), through a professional association (nurses, teachers, etc.), via a union affiliation, through an alumni association or via a chamber of commerce membership.

Cautions re: ‘inexpensive’ short-term policies

While small business plans might be cheaper for younger, reasonably healthy employees, those with older employees, or with a history of illness, can expect to pay higher premiums and deductibles. As such, the cost of health insurance will not necessarily go down. Also, the short-term policies recently proposed as inexpensive alternatives to ACA coverage have to-date been available only in 90-day increments. The Trump administration is recommending these policies be renewable beyond 90 days. However, such plans usually do not cover pre-existing conditions and often have extremely high deductibles.

This entry was posted
on Monday, October 30th, 2017 at 2:57 pm and is filed under Insurance Reform.
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2015 Open Enrollment

Here are 4 key dates you should know:

• November 15, 2014. Open Enrollment begins. Apply for, keep, or change your coverage.
• December 15, 2014. Enroll by the 15th if you want new coverage that begins on January 1, 2015. If your plan is changing or you want to change plans, enroll by the 15th to avoid a lapse in coverage.
• December 31, 2014. Coverage ends for 2014 plans. Coverage for 2015 plans can start as soon as January 1st.
• February 15, 2015. This is the last day you can apply for 2015 coverage before the end of Open Enrollment.