Open enrollment season for the Affordable Care Act marketplace, healthcare.gov, begins Friday, Nov. 1, and runs through Dec. 15.
People who currently have a marketplace plan will be automatically re-enrolled in the same plan or one offered by the same insurer that is similar for 2020. But even if you like your plan, it’s a good idea to review your coverage, as the prescription medications and doctors covered may have changed, or there may be new plan options that are a better fit.
The options, numbers, and jargon can feel overwhelming, but this is an important decision that will affect your ability to get health care — and how much it costs you — in the coming year. Here are some tips to help.
What is comprehensive health insurance?
Plans that meet all the ACA’s rules for basic coverage requirements, such as preventive care, maternity and mental health services, and prescription medications, are considered comprehensive. Such health plans cannot deny coverage for pre-existing conditions, and there is a limit to the amount members can be required to pay out of pocket.
Other types of insurance, including short-term limited duration plans and association health plans, are significantly cheaper because they are not required to cover basic services and can refuse to pay for care they determine is related to a pre-existing condition.
Even if you are shopping for comprehensive health insurance, it’s important to be aware of these other types of plans, because they are widely advertised online, and are often marketed to resemble full health insurance on websites that look a lot like the federal and state marketplaces.
Where do I buy comprehensive health insurance?
If you are buying insurance as an individual — and especially if you qualify for income-based tax credits — the safest and most reliable place to shop is the federal health exchange, healthcare.gov. The website lists only plans that meet the ACA’s requirements for comprehensive health insurance.
Private exchange websites may also be able to help you enroll in a marketplace plan, but these websites can also sell health plans with incomplete coverage and may not be required to show you all of the marketplace plans available in your area.
What types of plans are available?
ACA marketplace plans are organized by metal level: bronze, silver, gold and platinum. Bronze plans have the lowest monthly premium and the highest deductibles. Gold and platinum plans have the most expensive premiums, with lower out-of-pocket costs. Silver plans fall in the middle and are a popular option for marketplace shoppers.
The number of insurers and plan options for each metal level will vary depending on where you live.
How do I know which plan is best for me?
Premium (the amount you pay on a monthly basis to maintain coverage) is the number one thing consumers consider when shopping for health insurance, analysts say. But it’s far from the only factor that affects how much you will spend on health care in a year. The deductible (the amount you must spend out of pocket before the plan pays a greater share) and the out-of-pocket maximum (the maximum amount you can be asked to pay in a year) are also important. Consider whether your doctors are in-network and whether the medications you take are covered to avoid surprise costs later.
Who is eligible for tax credits and how do I get one?
Tax credits are available to offset the cost of insurance premiums for people within 400% of the federal poverty level — that’s an annual income of just under $50,000 for an individual in 2019. The amount of the credit depends on your income. People who are eligible for a premium tax credit can get extra financial assistance if they choose a silver-level plan. The easiest place to sign up for health plans with an income-based tax credit is the federal exchange website, healthcare.gov.
Where can I get help?
Navigator programs paid for by state and federal funds provide free, in-person support to help you select a plan. If you want an appointment, don’t procrastinate — funding for navigator programs has been cut dramatically over the past few years, which means fewer enrollment specialists are available.
Many independent brokers are certified to sell ACA marketplace plans. Brokers are paid commissions from insurance companies when they sell a health plan, and may sell both comprehensive health insurance and plans that do not offer full benefits.
Use the Pennsylvania Insurance Department’s broker search tool to verify that your agent is licensed and in good standing, and to see which insurers he or she has relationships with. New Jersey Department of Banking and Insurance has a similar tool. Brokers who have relationships with many common insurers will have more plan options to show you and may have less financial incentive to sell you a specific plan.