If anything is true of 2017, it is this: Confusion reigns. And nowhere do we see that more than in healthcare, where failed repeal attempts, executive orders, sudden, out-of-the-blue policy changes, and general unpredictable chaos have dominated the news.
But the fact remains that Americans still need access to medical care, and for those who don’t have insurance through their employer or the government, the 2018 Open Enrollment period for individual insurance plans officially begins on Nov. 1. So what are the things everyone should know, but which may have been overlooked amid the maelstrom?
We chatted with a half-dozen advocates, policy experts, industry professionals, and navigators about this year’s open enrollment period. Some spoke with us on the condition of anonymity, and some were happy to talk on the record, but all of them agreed overwhelmingly on a huge point: There’s massive confusion in the marketplace this year that they desperately want cleared up.
With budgets for advertising, outreach, and navigators dramatically slashed this year, getting vital messages to reach folks who need to know has been incredibly challenging, all said.
So we asked them: What do you wish you could just get a giant megaphone and shout from every mountaintop about open enrollment this year?
Across the board, answers were surprisingly consistent; here’s what they said.
1. The law still exists!
This was the number one point that every single person we spoke to hit: Despite efforts from the White House and Congress, the ACA has not been repealed, nor has it been amended, and what was the law in 2016 is still the law today.
“OBAMACARE IS STILL ALIVE,” one medical biller told us, enthusiastically. “All of it! If you qualify for a subsidy or Medicaid, you can still get it! You still don’t have to answer medical questions on your application!”
That was echoed by Claire McAndrew, the director of campaign strategy at Families USA.
“Despite all of the efforts going on by the Administration to challenge the Affordable Care Act, despite all the news about changes to the law, number one: The law still does exist,” McAndrew told Consumerist.
“We really don’t want people to be confused by news that’s out there,” McAndrew added, “Because none of that changes the fact that Open Enrollment starts November 1st and that plans are available for consumers.”
Erin Hemlin, director of training and consumer education for Young Invincibles, said the same.
“The marketplaces are stable, and the marketplaces are open,” Hemlin said. “The law is still the law, and the comprehensive plans are still available.”
Hemlin added, “All plans are comprehensive, all plans must cover a certain set of medical services, so you know you’re getting comprehensive coverage that’s actually going to be there when you need it — and they cannot discriminate against you because of a preexisting condition. That’s still against the law.”
2. Enrollment starts Nov. 1, and ends Dec. 15 — don’t procrastinate!
Anyone who wants to enroll for a plan in 2018 has literally half the time that was available in previous years. The deadline used to be Jan. 31; the administration quietly cut that back to Dec. 15.
“It is a shorter open enrollment period this year, so I’d really urge people not to wait to enroll,” McAndrew said. “Maybe get online right at the beginning of open enrollment, Nov. 1.”
“Young people, especially, are really busy during this time of year,” Hemlin said. “That Dec. 15 deadline can be a hectic time,” at the end of school terms, with everyone’s holiday plans ramping up and schedules getting crowded, “and this might not be the first thing that they’re thinking about.”
Usually, Hemlin added, there’s a spike of enrollees in late January, just before the deadline, once New Year’s has passed and everything’s calmed down a bit. But this year, if you wait that long, you’ll be out of luck.
Experts’ advice: Don’t procrastinate! “Even if you live in a state that has more time to enroll, it’s not going to hurt you to get enrolled before [Dec.] 15th,” Hemlin said.
3. You can still get financial help, and plans may be more affordable than you think.
Yes, the White House is blocking billions of dollars of reimbursement to insurers to cover the subsidies they have to give lower-income consumers. That has made some premiums go up — some, but not all. And the tax credits that millions of other marketplace shoppers receive are still in place, too.
“If you look at a typical marketplace shopper, 8 in 10 have incomes that qualify for premium subsidies,” Hemlin said. “So if you are one of these 8 in 10 people, you are essentially insulated from any premium increases, because your tax credits go up as premiums do.”
“Although there have been policy changes to the cost-sharing subsidies,” McAndrew added, “The fact remains true that if you are eligible for premium subsidies, or lower-cost deductibles or out-of-pocket costs, that is still the law.”
“Don’t give up if you have problems getting approved for a subsidy,” one navigator stressed. “Get help. Document all your phone calls.”
All the experts we talked to also suggested making sure you don’t just blindly stick with your old plan or re-enroll without making sure you look carefully and shop around.
“You might even be able to get a plan that’s a little bit cheaper this year, which is why we are really encouraging people to actively renew, or to go on and update their information and shop around,” Hemlin said.
4. You may be eligible for coverage even if you think you’re not.
There are a lot of reasons you might be hesitant to shop for a plan: income level, immigration status, cost of coverage, or even the fact that you have a job that offers coverage. However, it still may be worth popping over to the website and at least window-shopping for a plan.
“You can buy an ACA plan even if you work full-time or even if you have employer insurance,” the medical biller reminded us. “It’s not just for low-income people! You probably won’t qualify for a subsidy, but any human being can buy an insurance plan on the exchange,” and depending on your situation, it may suit your needs better than you thought.
A navigator added, “If you’re working and have employer insurance, but have a low income, you might still be eligible to have Medicaid as a secondary insurance. If you don’t qualify, your kids or your pregnant spouse might.”
“If you have high income,” they continued, “you might still want to put your kids on CHiP because it’s great coverage — and you might like shopping for a plan on the marketplace, because there are tools there that make it easy to compare plans between the different insurers in your area.”
“You don’t necessarily have to be a citizen to get an ACA plan, but options for various categories of immigrants vary by state,” the navigator told Consumerist.
That sentiment was echoed by McAndrew: “It’s just really important to shop around, because until you go to that marketplace and actually shop around, you don’t know what you’ll qualify for.”
5. You can still get help.
The marketing budget may have been trashed, but navigators and non-profits are still right there, ready to help you sort this out.
“The resources that were available before still are available,” McAndrew stressed. “In terms of going to healthcare.gov, or taking advantage of the call centers — we still have plan options and there is still a call center to get help.”
“There are a number of different groups that are providing information. In your local community there will be navigators and assisters you can get information on. Look into your local community: Look into health centers, and look into the resources that were there last year for in-person assistance,” she added. “Resources that were there last year for in-person assistance will be right there this year; resources that folks relied on for in-person assistance should not be forgotten this year.”