eHealth Identifies the Top 10 Things Every Health Insurance Shopper Should Know During the 2016 Obamacare Open Enrollment Period
Consumers should look for changes to their premiums, deductibles, benefits and eligibility for subsidies, as well as new plans on the market; shopping early is the secret to avoiding stress during open enrollment
MOUNTAIN VIEW, CA – November 16, 2015 – Today eHealth, Inc. (NASDAQ: EHTH – eHealth.com), the nation’s first and largest private online health insurance exchange, identified the top ten things consumers should look for during the Affordable Care Act’s 2016 nationwide open enrollment period.
The Affordable Care Act (ACA, commonly referred to as “Obamacare”) created nationwide open enrollment periods when all qualifying individuals and families are able to apply for government subsidies and enroll in major medical health insurance coverage. The open enrollment period for 2016 health insurance plans started November 1, 2015 and is scheduled to continue through January 31, 2016.
“Open enrollment is important for everyone who buys health insurance,” said Gary Matalucci, eHealth’s Vice President for Customer Care. “It’s the one time of year when everyone should reconsider their health insurance options, because the best plan for you in 2016 isn’t necessarily the plan you had in 2015. In fact, this open enrollment period might be your only chance to change your current health insurance plan before 2017! If you need help understanding your coverage options, eHealth is here for you.”
10 Things All Health Insurance Consumers Need to Know
During the 2016 Open Enrollment Period:
1. Your monthly premiums will probably change in 2016 – Some consumers may actually see their monthly premiums decrease, but chances are you’ll see a modest increase in your insurance rates. A Kaiser Family Foundation analysis of 11 cities shows that monthly premiums for benchmark plans are increasing an average of 4.4%, though some cities will see an increase of 10% or more1. Consumers qualifying for subsidies might not feel these rate increases, since subsidies often keep pace with premiums. But if you don’t qualify for subsidies, rising prices can hit you right in the wallet.
2. Your annual deductible and copayments may change too – Even if your monthly premiums aren’t changing significantly, pay attention to any changes in your out-of-pocket medical costs for 2016. Are your copayments increasing? What about your annual deductible? Don’t overlook out-of-pocket costs when reviewing your coverage options. A recent eHealth report shows that what you pay out of pocket for prescription drugs and medical care has a big impact on your overall satisfaction with your health plan2.
3. Your 2015 health insurance plan may be discontinued. Some insurance companies are no longer offering certain 2015 health insurance plans in 2016. Insurance companies sometimes retire older plans or simply opt to leave a specific market. Others may be closing down PPO plans in favor of HMO plans. If your 2015 health insurance plan is going away, you’ll need to get out there and shop for something new – and re-apply for any subsidies you may have qualified for in 2015.
4. On the other hand, new plans may be available to you. Though some insurers are retiring old plans, others are rolling out new individual and family health insurance plans for 2016. Get familiar with any new health insurance offerings in your area. You may find that one of these new plans is well suited to your personal coverage needs and budget.
5. You could see changes in your benefits or access to network doctors. Whether you’re keeping your 2015 plan or enrolling in something new for 2016, be aware of how you may be affected by changes to your coverage or to your network of doctors and hospitals. Are the drugs you use still covered at an affordable copayment? Is you preferred doctor still in your network? Some insurers are moving to a two-tiered network model where you pay a higher or lower copayment depending on which medical providers you want to see. Pay attention to changes of this sort and make sure you’re still getting the coverage and access to care you need for 2016.
6. You may need to actively opt-in to stick with your current plan. Depending on the rules in your state, if your insurance company makes certain changes to your coverage for 2016, you may need to actively indicate you want to stay enrolled in your plan next year. Otherwise, you could end up without coverage on January 1. Contact your licensed agent or insurance company to learn more.
7. Subsidies can get complicated – you may want to re-apply. The federal government generally makes subsidies available to qualifying applicants earning up to 400% of the federal poverty level, but subsidies can get really complicated. Did you indicate that you wanted your 2015 subsidies to be automatically recalculated for 2016? If not, they could disappear on January 1. And even if your subsidies automatically renew for 2016, the dollar value of those subsidies could change based on a variety of factors. Better to play it safe and re-apply for 2016 subsidies during open enrollment.
8. If you’re not getting subsidies, you have extra coverage options to choose from. If you earn too much to qualify for government subsidies (that is, more than about $47,000 for a single person or about $97,000 for a family of four, in most areas), you actually have additional coverage options to choose from that cannot be purchased using subsidies. Private online marketplaces like eHealth offer Obamacare-compliant health insurance plans that meet your coverage requirements under the law and which aren’t available through government-run exchanges.
9. You could face a steep tax penalty for going uninsured in 2016. The law generally requires most Americans to have qualifying coverage or face a potential penalty on their federal taxes. If you are uninsured for longer than two consecutive months in 2016, you could face the biggest-ever Obamacare tax penalty: $695 per adult (and $347.50 per child) or 2.5% of your taxable household income, whichever is greater, subject to certain limits and exceptions.
10. You can save yourself stress and hassle by shopping early. Open enrollment started November 1, 2015 and is scheduled to run through January 31, 2016. The earliest that coverage under a new plan can begin is January 1. For a smoother transition from your 2015 plan to your 2016 plan, you may want to enroll before December 15, 2015. Whatever you do, don’t put off shopping for 2016 coverage until the last minute. Give yourself time to understand your options and get professional help and advice if needed.
1 Source: Kaiser Family Foundation, Analysis of 2016 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces, June 2015.
2 Source: eHealth’s October 2015 report, Consumer Satisfaction & Spending for Prescription Drugs and Medical Care.
eHealth, Inc. (NASDAQ: EHTH) owns eHealth.com, the nation's first and largest private health insurance exchange where individuals, families and small businesses can compare health insurance products from leading insurers side by side and purchase and enroll in coverage online. eHealth offers thousands of individual, family and small business health plans underwritten by many of the nation's leading health insurance companies. eHealth (through its subsidiaries) is licensed to sell health insurance in all 50 states and the District of Columbia. eHealth also offers educational resources and powerful online and pharmacy-based tools to help Medicare beneficiaries navigate Medicare health insurance options, choose the right plan and enroll in select plans online through PlanPrescriber.com (www.PlanPrescriber.com), eHealthMedicare.com (www.eHealthMedicare.com) and Medicare.com (www.Medicare.com).