With the deadline fast approaching, many Pennsylvania residents who could get better deals on health insurance by shopping around have not yet done so, a new healthcare.gov enrollment report shows.
Open enrollment is just half as long as it was last year, ending Dec. 15. As of Nov. 25, just 124,081 people from Pennsylvania had enrolled in 2018 plans through the Affordable Care Act marketplace— less than a third of the 2017 season-end total of 426,059.
County numbers are not yet available, but for 2017 there were 16,082 enrollees from Lancaster County.
Many of the current enrollees will be automatically re-enrolled if they don’t pick a 2018 plan by Dec. 15, but that could mean they pay more than they would have needed to, or have to find new doctors.
In Lancaster County, Highmark is switching all its individual plans here to an EPO — Exclusive Provider Organization — model that will not cover care from WellSpan Ephrata Community Hospital, UPMC Pinnacle Lancaster and Lititz, or associated providers, except in emergencies.
Unless they pick other plans by Dec. 15, current Highmark enrollees will be automatically put in those new plans and will not be able to switch.
Similarly, people who have silver plans will automatically be put in them again, even though some could be better off with a bronze or gold plan.
"This is a huge shift from previous years when folks had time to change plans once auto-enrolled," said Antoinette Kraus, executive director of Pennsylvania Health Access Network. "Because of changes in plans and prices, it is extremely important that individuals go back and shop to find the best option."
"A big reason why people aren’t signing up is because the insurance companies are sending out renewal reminders that show 2018 prices based on 2017 premium tax credits, thus showing an incorrect cost," said Daniel Sosa, an outreach and enrollment specialist with SouthEast Lancaster Health Services. "People take one look at it and throw their hands up and say 'I can’t afford that.' The sad part is, that price can be easily corrected by manually submitting your 2018 application."
In the past, silver plans have generally been the best deal for those with income under 250 percent of the federal poverty level — $30,150 for one person, $40,600 for two and $61,500 for four — because they qualified for extra cost-sharing reductions.
But due to several weird twists, for some that is no longer true.
For example, the cheapest 2018 plan a Lancaster County 40-year-old earning $25,000 can get at each metal level with federal subsidies is as follows.
- Bronze: $0 monthly premium, with $6,100 deductible and $7,350 out-of-pocket maximum.
- Silver: $137 monthly premium, with $3,500 deductible and $5,850 out-of-pocket maximum.
- Gold: $94 monthly premium, with $3,000 deductible and $7,350 out-of-pocket maximum.
Daily enrollment has been high compared to previous years, but experts say the shorter season will make it difficult to match last year’s numbers, particularly as a major poll has shown many people don’t know that the season is shorter this year.
This story was updated at 8 a.m. Dec. 4, 2017, to add Sosa's comments.