Window shopping for 2018 is now available on healthcare.gov, and it shows a weird twist: The Washington brouhaha that was largely responsible for raising individual health insurance premiums an average of 31 percent in Pennsylvania also means that, for the first time, some Lancaster County residents will be able to get plans for free.
Others will be able to pay less for better plans than they had last year, or find better options if they look outside healthcare.gov.
Open enrollment for all individual plans, both on and off the Affordable Care Act marketplace, will run Nov. 1 to Dec. 15, just half as long as last year.
Experts always advise shopping carefully, but this year, they say those who don’t could miss a chance to save thousands of dollars.
This year 16,082 county residents have coverage through the marketplace, and others bought insurance off the marketplace or went uninsured.
Here’s what they should know as they consider their options.
Plan classifications reflect the normal size of deductibles. Bronze generally has the lowest premiums and highest deductibles, with gold having the highest premiums and lowest deductibles, and silver in between.
However, the law requires special cost-sharing reductions, or CSRs, that lower out-of-pocket costs on silver marketplace plans for those with income up to 250 percent of federal poverty level (see sidebar).
The law also uses silver plans as the yardstick to set federal premium subsidies that are available up to 400 percent of the federal poverty level, which can be used for any marketplace plan.
The Trump administration recently announced it would no longer reimburse insurers for CSRs. In response, regulators in Pennsylvania and many other states allowed insurers to hike just their 2018 marketplace silver premiums, and to set lower premiums for silver plans offered only outside the marketplace.
The result for subsidized marketplace enrollees is that federal assistance increased by more than bronze and gold premiums did, so those plans are cheaper or even free for 2018, while silver plan costs are staying about the same. In some cases gold will be cheaper than even silver with CSR.
And for people who don’t qualify for subsidies, off-marketplace-only silver plans are cheaper than on-marketplace ones.
By the numbers
Consider the healthcare.gov options of a 40-year-old county resident who earns $30,125. At that income level, costs are similar for older and younger people.
- In 2017, after subsidies and CSRs on healthcare.gov, she could choose from one bronze plan with a monthly premium that cost her $127; four silver averaging $219; and three gold averaging $334.
- In 2018, there are four bronze plans averaging $11, including one at $0; three silver averaging $239; and three gold averaging $198.
If that same 40-year-old county resident earned $48,241, she would be just over the limit for federal subsidies. At and above this income level, younger people pay a lot less and have access to bare-bones “catastrophic” plans offered only to those under age 30, and older people pay a lot more.
Without subsidies, her options on healthcare.gov would be as follows.
- In 2017: one bronze plan at $451 a month; four silver averaging $542; and three gold averaging $657.
- In 2018: four bronze averaging $490; three silver averaging $742; and three gold averaging $700.
But if she looked at the four 2018 silver plans offered only off-exchange, their average premium would be $573.
Where to start
People who will likely qualify for subsidies can go to healthcare.gov/see-plans/#/ and enter basic information including ZIP code, age and expected household income to see how much financial help they can get and start browsing plans.
Healthcare.gov will go live on Nov. 1, but Acting Pennsylvania Insurance Commissioner Jessica Altman noted that federal officials have said it will be down for maintenance from midnight until noon on every Sunday except Dec.10.
People who may not qualify for subsidies should visit the state-sponsored comparison site pa.checkbookhealth.org, which asks for similar information and shows options both on and off the marketplace, on or after Oct. 30.
Don’t rely on auto
Some current healthcare.gov enrollees who don’t make a selection during open enrollment will be automatically re-enrolled in this year’s plan or a similar one.
Daniel Sosa, an employee of SouthEast Lancaster Health Services who’s trained to help people during open enrollment, said most of the old plans are going away, and the ones that are remaining have changes.
So, he said, particularly this year, people who don’t update their information and select a plan for 2018 risk having their doctors not covered, or paying a lot more money than they need to.
In addition to premiums, other important factors when assessing plans are deductibles, out-of-pocket maximums, co-pays, prescription drug coverage and which doctors and offices are part of the plan’s network.
Deductible ranges for 2018 are as follows: bronze $6,100 to $7,350; regular silver $4,650 to $7,150; gold $1,000 to $3,000; and CSR silver, depending on income, from $250 to $4,500.
Networks are especially important this year because Highmark, which previously covered most area providers, is switching its individual plans to an Exclusive Provider Organization that, in this region, generally covers only Lancaster General Health and Penn State Health Milton S. Hershey Medical Center, except for emergency and urgent care.
Sosa said it’s important to call doctor’s offices to verify whether they’re in-network on plans being considered.
“Open enrollment closes on Dec. 15, so if the year starts and you realize they don’t have my doctor, you cannot change in January like you could in years before; you’re really stuck,” he said.
Localhelp.healthcare.gov has a list of organizations offering free enrollment assistance. Locally, SouthEast Lancaster Health Services is prominent; its enrollment office can be reached at 717-917-3756.
Coming to healthcare.gov for the first time this year is a “Help On Demand” button that will give nearby enrollment assisters a chance to connect digitally with someone who’s seeking help.
Various other organizations also offer free help. For instance, Lancaster General Health offers free enrollment assistance through a company called Change Healthcare, which can be reached at 717-544-6700.
Additionally, fee-only insurance advocate Joshua Brooker has set up an independent Lancaster-based advisory firm called PA Health Advocates that looks at both the plan options and tax approaches to get the best deal.
For instance, Brooker said, a single person with household income of $48,240 can get subsidies but someone at $48,241 can’t, so using tools like an IRA deduction to keep household income within subsidy levels can be helpful. Or people may qualify for an exemption from the requirement to have insurance.