With the annual sign-up period for plans on the health law鈥檚 marketplaces starting Nov. 1, many about rising premiums, shrinking provider networks and the departure of major insurers such as UnitedHealthcare, Aetna and Humana from many exchanges.
The impact on coverage will vary, but the shifting landscape means that it鈥檚 more important than ever for consumers to carefully evaluate the plans that are available in their area and choose the best one for their needs. There are several elements to factor into that decision.
It鈥檚 crucial to log into the marketplace and review plan details. Comparing plan premiums and deductibles only scratches the surface of what you should evaluate before selecting a plan this fall. Policy details can make an important difference in coverage and costs, but it may take some digging to uncover them.
Avoid Premium Sticker Shock
Premium increases for 2017 will generally be higher than last year鈥檚 rate hikes, though with significant geographic variation. In the two-thirds of states where the federal government runs the marketplace, the average premium increase for the second lowest cost silver plans will be 25 percent next year, according to a by the Department of Health and Human Services. Last year, the comparable premium increase was 7 percent. The average premium, before tax credits, for the lowest cost silver plan will be $433.
About have incomes of up to 400 percent of the federal poverty level (about $47,000 for one person) and听qualify for federal tax credits to help pay their premiums. If you are one of these consumers, it may be necessary to switch plans to minimize your share of the premium because your tax credit is pegged to the second lowest-cost silver plan in your area, which often changes from year to year.
Next year, three quarters of people can find a cheaper plan at the same metal level if they come back to the marketplace to shop. Consumers who bought the lowest cost silver plan in 2016 can by switching to the cheapest silver plan next year, according to HHS.
People with subsidies 鈥渃an insulate themselves from premium increases by selecting one of the lowest cost silver plans,鈥 said Caroline Pearson, a senior vice president at the consulting firm Avalere Health.
If you鈥檙e currently buying an individual plan but not going through the marketplace, be sure to recheck your eligibility for subsidies. Federal officials estimated earlier this month that who purchased coverage outside the exchanges have incomes that would qualify for financial assistance.
Look For Hidden Benefits
A close look at plan details may show that coverage is more generous than it appears. Even as deductibles continue to rise, many plans are offering coverage for certain services before the deductible is satisfied. So instead of having to pony up the entire cost of your visit to the doctor or your prescription drug until the deductible is paid off, you may just owe a copayment.
This year, for example, sold on听healthcare.gov covered primary care doctor visits before the deductible. Half of plans covered generic drugs before the deductible.听(In addition, the health law requires that many preventive care services, including tests and screenings, vaccinations and contraceptives, generally be covered without requiring people to pay anything out of pocket in all听new marketplace plans.)
This practice can serve two purposes. Encouraging primary care may save insurers money down the road on more expensive treatment. And exempting some services from the deductible could help make plans more appealing to the relatively healthy people insurers want to attract and who might otherwise balk at policies with a typical deductible of around $3,000.
鈥淧art of it is trying to give people some value even if they鈥檙e not high users of health care,鈥 said Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities in Washington, D.C.
Sidestep Automatic Reenrollment听
Insuring Your HealthIf your plan is continuing next year, you may be automatically renewed, but that may not be your best option. Do some comparison shopping on marketplace plans to see whether there are changes to plan benefits or provider networks that matter to you and how 2017 pricing will affect your听subsidy.
If your plan is not going to be available next year and you don鈥檛 actively pick a new plan, you may find yourself with similar costs and benefits. But that can mean changes in the list of approved drugs or losing access to your favorite hospitals and doctors, among other things.
Pay attention to timing. Enrollment ends Jan. 31, but to have coverage that starts Jan. 1, you must make a choice by Dec. 15.
Check Out New Standardized Plans
Next year,听healthcare.gov听will join several state-based marketplaces in offering that are expected to help consumers make apples-to-apples comparisons between plans at the bronze, silver and gold levels and cut down on confusion caused by a sometimes bewildering array of options.听In these “simple choice” plans, the deductibles and annual听limits on out-of-pocket spending听will be standardized,听as will many of the consumer payments for medical services.听For example, the standardized silver plan will have a deductible of $3,500 and the maximum amount you will owe out of pocket for the year will be $7,100.
In addition to standardized benefits, many of the plans cover a number of services before the deductible is satisfied, such as primary care and specialist visits, drugs, urgent care and outpatient mental health.
Many standardized plans also rely on copayments (fixed amounts that you pay for a service), rather than coinsurance (a percentage of the cost of the service), to a greater extent than people may see in听regular marketplace plans, said Sabrina Corlette, research professor at Georgetown University鈥檚 Center on Health Insurance Reforms. Insurers aren鈥檛 required to offer standardized plans in most states, but the federal government is promising that the plans will be听 prominently displayed on听healthcare.gov.
Dig Into Prescription Drug Details
Drug coverage is a big concern for many people, but finding plan details can be tough. You can check out a plan鈥檚 list of covered drugs through听healthcare.gov, but determining what your share of the cost will be can be more challenging. That鈥檚 because even though state marketplaces typically only show four cost-sharing tiers online, many plans have five, six or even more tiers. In 2016, 40 percent of silver marketplace plans had more than four cost-sharing tiers, according to Avalere data.
Also, insurers on the exchanges may require that your doctor or other health provider get prior authorization from the insurer before prescribing some drugs for you or demand that you try a less expensive drug before getting a more expensive one, a practice called step therapy, said Pearson.
鈥淚f you鈥檙e a consumer that has a lot of drug costs or takes specialty medications, actually consulting the plan documents is important, because you need more granularity than is available on the website,鈥 said Pearson.
Check Provider Networks
You will be able to check which doctors and hospitals participate in the plans you鈥檙e considering on healthcare.gov. That鈥檚 increasingly important as networks continue to narrow and fewer plans offer any out-of-network coverage. An initiative by the federal government to communicate whether a plan鈥檚 network is basic, standard or broad in all states using the federal marketplace to a four-state pilot in Tennessee, Maine, Ohio and Texas.
Use Caution When Shopping Off The Marketplace
If the marketplace plans don鈥檛 appeal and you don鈥檛 qualify for subsidies, you can shop for individual market coverage off the exchanges, although the number of such offerings has been declining, said Katherine Hempstead, who directs health insurance coverage research for the Robert Wood Johnson Foundation.
Off-exchange plans can鈥檛 be too wildly different from what鈥檚 available on the exchange, because they also have to cover听the essential health benefits and offer plans in metal tiers that cover the same proportion of care as those on the marketplace, among other things. But in some markets, plans may offer different or broader provider networks outside the exchanges, said Corlette.
There鈥檚 a potential downside, however. If your income is too high to qualify for subsidies at the beginning of the year, you may qualify for them later if your income drops 鈥斕齠or example, if you lose a major client. But that鈥檚 only an option if you鈥檙e already enrolled in a marketplace plan.
鈥淚f you鈥檙e enrolled outside the exchange and you have a change in income, you can鈥檛 qualify for a special enrollment period to sign up for a different plan,鈥 Corlette said.
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