Open Enrollment on Healthcare.gov started this morning.
With the somewhat small exception of the Texas v Azar case that is currently hanging out at the 5th Circuit which, if affirmed, could throw out the entire law, I expect the open enrollment period to be fairly straightforward.
I expect total on-exchange enrollment to decrease by a few percentage points for a couple of reasons.
- Slightly worse pricing net of subsidy as spreads between Benchmark and cheapest plans compressed
- Reinsurance is compressing on-exchange premium spreads
- More Medicaid Expansion moves people who were buying plans and earning 100-138% FPL to Medicaid
- Maine and Virginia have hit their strides
- Mountain West expansions states are slowly starting up
- More off-ramps this year with wide spread marketing of short term limited duration plans, cost sharing ministries and association health plans
The biggest thing that could boost enrollment is if the Health Reimbursement Account scheme takes off quickly. I think that is more of a 2020 thing for plumbing reasons but I could be wrong.
I don’t expect to see much difference in enrollment due to outreach and advertising. We have baked into the baseline a very low level of advertising and assistance already, this is not new.
There is little to no policy uncertainty during the pricing cycle. There are no policy shocks. There is no free, earned media like in the Fall 2017. This is a business as new usual year.
Now let’s just go back to an earlier post on choosing insurance as that applies here as well:
- Insurance is complicated
… I know my limitations. I am very confident that I won’t make a horrendous choice. I am also very confident that I won’t make the optimal choice. And I’m okay with that. When I have to choose an insurance product, I engage in a strategy that minimizes my regret. I’m okay with sacrificing some perfection as long as I know that my eventual choice is at least good enough. The extra two or three or thirty hours of gaming out every potential scenario is not worth the time nor the stress.
- Identify what you value
How important is access to a particular set of doctors or hospitals? This will be a mixture of your health status and the learning/hassle costs of switching docs….
How much can you afford in a worse case scenario versus how much can you pay out each month? This is a tough trade-off. All else being equal, a higher monthly premium means more protection in a worse case scenario (that is less likely in the ACA as there are an increasing number of gold and silver plans with the same out of pocket maximum as bronze plans but merely take a lot more time/claims to get there). For a given monthly premium, what are you willing to concede to get a targeted level of protection? How important is a cap on exposure?
- Know where your help is
Insurance can be complex.
Most people don’t spend several thousand hours a year thinking about insurance markets. Some people do. Use those people.
Good luck, and ask for help in comments as needed.
Raven Onthill
As of just now the exchange web site in our state shows the following message: “Washington Healthplanfinder is down for maintenance and has limited capabilities. We expect to be back online within a few hours.” The message wasn’t there a few minutes ago but the site wasn’t working. They’ve had some sort of crash.
Pfffbt.
On top of which (repeat from previous), our health insurance company has decided to leave the Exchange in our county, apparently taking my family’s entire health care team with it. Probably. I’ll know for certain when the Exchange site is finally up.
Thrills! Chills! Life-threatening ills!
germy
Long term care insurance for a NY State resident.
Which providers to avoid, which are recommended?
Butch
I was laid off last year and as a result we qualified for a subsidy. I’ve been filling in with part time work but want to go back to full time, but it’s unlikely I’ll find something with health insurance (long story) and it will mean we lose the subsidy, so a good portion of the “extra” earnings will go to health insurance. I’m not sure there’s a good answer.
Betty Cracker
Warren is out with Part 1 of her M4A plan.
David Anderson
@germy: I know nothing about long term care insurance besides it is a mess.
germy
@David Anderson: Thanks for the warning, anyway.
germy
@Betty Cracker:
Gremcat
I took early retirement in April of this year and am eligible for COBRA until next October next year. Should I sign up for ACA this year or wait till next October when COBRA runs out? I won’t qualify for a subsidy this year in any case, but I might next year.
Another Scott
Krugman weighs in on Warren’s M4A funding proposal.:
Cheers,
Scott.
guachi
The problem I have with M4A is that it’s too much at a time where there isn’t the desire for such a big thing. Democrats got smashed in 2010 for doing much less. I think it’s an unnecessary own goal on Warren’s part.
Do M4A Lite and add a public option that allows companies to buy Medicare coverage for their employees. It seems like it’s a much easier sell.
germy
@guachi: But when negotiating, is it wise to start with lite? What would lite be whittled down to?
Ohio Mom
@germy: Have you consulted with an Elder Law attorney? Yes, it’s expensive but they know things about sheltering resources, working the system, and related issues that the rest of us have not a clue about. I imagine they are very familiar with the various long-term care insurers.
justawriter
North Dakota Insurance Commissioner challenges world’s tallest politician record. His most noteworthy achievement.
germy
@Ohio Mom: Thank you.
Brachiator
@Gremcat:
Wouldn’t cost be an issue? In California, at least, COBRA is often more expensive than ACA plans. Also, are you eligible for Medicare?
Not an expert in these matters at all. Just had a couple of co-workers in a similar situation. One was able to get onto his spouse’s plan, avoiding the issue of COBRA entirely
Also, some companies have a retirement Health Savings Account plan. Make sure you know what all your options are in terms of what your company offers,
Kelly
We’ll be sticking with our Bronze Kaiser HSA plan. Premium is $6.49 a month after a $1349.76 subsidy. Individual deductibles $6900. This works for us because it moves our health insurance costs out from under the 400% of poverty line subsidy cliff at $67,500 for 2019. HSA contributions are excluded from our income calculation. HSA contribution limits are $7,000 per family plus $1,000 for each of us as we are over 55.
Kineslaw
A relative is insulin-dependent, taking Trujeo and Novalog and subsidized ACA. Also split time between Texas (main residence) and Florida.
What do they need to look for in a plan?
Thanks.
dr. bloor
BC/BS of RI taking an interesting approach to dealing with individual buyers (both on and off exchange). Modest premium and deductible increases this year, chiefly due to state’s reinsurance program. BUT, reimbursement for specialist providers will be clipped by 30% as compared to enrollees with group commercial plans (does not include PCPs and Behavioral Health providers, who are already reimbursed at around Medicare rates).
It’s like the old liquor distributor scheme: If you wanna buy the top shelf scotch, you gotta take a couple cases of rye as well.
Gremcat
@Brachiator:
Thanks for the response. I won’t be eligible for medicare for 8 years. The company is paying for COBRA till the end of this year. My husband will transfer to medicare at that point but I will need to get ACA. We will not be eligible for any ACA subsidies this year, but will after next year.
Ohio Mom
@germy: Don’t thank me yet, the hard part is finding a competent attorney.
I know about Elder Law because those are the same attorneys who also do special needs trusts — there is a lot of overlap because the same government programs apply to both populations (Social Security, Medicaid, Medicare), and they also share legal issues such as considering guardianship.
The first attorney we paid to draw up Ohio’s Son’s special needs trust did it wrong. The second one corrected everything and taught us lots we needed to know.
Good luck!
Ohio Mom
@Kineslaw: Among everyone else I’d ask, I would check with their endocrinologist’s offices for advice. They argue with insurance companies all day long and may have some insight about which companies are easiest/most difficult to deal with.
Ohio Dad just got his first insulin pump. It’s making managing his Type 2 diabetes much easier but getting the insurance company to approve it was a slog.
Another Scott
@Ohio Mom: +1. Eldercare lawyers are very helpful, and even an hour can get one lots of good information.
My MIL was able to get a John Hancock LTC insurance policy and it was very, very helpful. It paid $200 a day for 3 years, and only 3 years, so it’s important to try to figure the best time to start claiming the benefit.
(I vaguely recall that many companies got out of the LTCI business because their estimates of benefits were way, way out of whack compared to what they brought in. JH apparently got out of the business of selling new policies at the end of 2016.)
Cheers,
Scott.
the Conster
I’m not supporting anyone who wants to repeal and replace Obamacare with $52 TRILLION pie in the sky. We lost 10 years of progress because blue dog Dems fought for the ACA, and many lost their seats. Why on earth does anyone want this government controlling healthcare? The Hyde Amendment isn’t going away which bakes in 2nd class citizenship for women, and every change in Congress and/or the president means that HHS’s rules and regs about what and who gets covered – like women’s healthcare – is constantly under assault. We’re not a European country that is a size of one of our states with a mostly homogenous demographic not propagandized by Fox and now with a far right SCOTUS ready to kill the ACA. With the current Senate and filibuster rules, WTF is Warren smoking? The most we can hope for is a public option buy in and making sure pre-existing conditions are covered, Medicaid expansion, and that’s what we should be selling. Warren is Bernie in a sweater set. Disappointing.
Another Scott
@the Conster: Warrens’ plan is out:
(Emphasis added.)
She’s laid out a long-term goal and how to pay for it in a serious way. She’s not saying it’s her way or the highway. She’s left plenty of wiggle room to improve Obamacare, compromise on sensible ideas on all the details, and all the rest, while working on the long-term goal.
FWIW.
Cheers,
Scott.
Brachiator
@Gremcat:
Your company is paying for COBRA? This sounds great. I hope this allows you some flexibility in helping you make your health care decisions.
the Conster
@Another Scott:
Everyone is going to figure out she’s lying about middle class taxes not going up no matter how much she tries to focus on costs, and her admission that there will be a loss of millions of good healthcare jobs, along with telling them they have to give up their private insurance, isn’t going to convince them to pay more taxes while also paying premiums, it’s going to piss them off. This will be a Mondale level wipeout, with no coat tails.
Kineslaw
@Ohio Mom: Thank you. There are only 3 companies to choose from, one of which is new. The out-of-pocket maxes are just ridiculous now.
Mart
@Gremcat: I was early retired last spring. I found the ACA options significantly cheaper than COBRA, lower monthly premium and much lower deductibles. Income from my wife’s part time job keeps us well below the “poverty” level of income, so the ACA pays most of the premium. Main issue was my wife freaking out over having to find new primary care, new oncologists, and even new more distant urgent care centers. Took awhile, but we feel good with the docs we now have. Cigna sent me an auto-renewal form yesterday. Monthly premium went up $170. Believe you can pay for COBRA with Health Savings Account funds. You cannot pay the ACA premium with HSA funds. You can pay ACA premium with unemployment insurance. I am in a red state that has not accepted ACA expansion.
Hurry up age 65!
Raven Onthill
Ayup. Mostly we are being directed to the two local care firms, one of which is Catholic and dangerous, especially to young women and dying elders, the other of which is notorious for inadequate treatment and price-gouging, and then there is Kaiser. All available Exchange plans are either HMOs or EPOs; going out of network is not a plausible choice.
Raven Onthill
Anyone who thinks the ACA is wonderful is not dealing with it in a coverage desert.
On the choice between an ACA plan and COBRA: the ACA could be declared unconstitutional, but probably will not be so declared before the 2020 election.
Butch
@Raven Onthill: We are in a coverage desert. Even with premium support the plans are anything but “affordable” and the Bronze plan, which as it is stretches our budget, covers almost nothing.