The Open Enrollment Period (OEP) for the Affordable Care Act’s (ACA) individual health insurance markets started at midnight.
OEP is the time of the year when anyone can sign up for a policy for any reason. OEP is typically a limited time period in order to minimize adverse selection which can be thought of as people only buying insurance when they know that they have a huge medical expense coming up. The OEP period for almost the entire country runs from November 1, 2021 to January 15, 2022. Some states that run their own marketplaces may run their OEP longer.
If you are already enrolled, your insurer can roll your current choice to next year. However this is unlikely to be optimal for you. Premiums that you pay are likely to change and there might be better options available. Automatic re-enrollment is important but it could place people into objectively dominated plans.
Active choice reduces but does not eliminate the possibility of a bad decision being made.
Choosing insurance is hard. It is particularly hard this year as the subsidy system has changed, and the choice space is massive. Almost two thirds of the country that uses Healthcare.gov will see at least 50 choices. A third of the country that uses Healthcare.Gov will see at least 100 choices. Houston and Miami have 200+ choices.
Right now people who are looking for insurance have time. USE IT. Get help. Poke me in comments or e-mail me at my balloon-juice address. Find a navigator or a Certified Assistance Counselor. Brokers and agents, especially those who have either a fiduiciary relationship OR are seeking a long term relationship can be wonderful experts to help figure out what few plans are likely to hit your needs well enough. Accept that you are unlikely to get a perfect choice but that you can likely get a good enough choice most of the time.
Big Picture Pathologist
Thanks for the reminder.
I was planning on sitting this Open Enrollment out since I was pretty satisfied with my United Healthcare/AARP until I found out UH used Walmart for their online pharmacy and then they pulled that crap over the summer about denying ER visit coverage if they didn’t approve of the reason.
If anyone wishes to recommend a plan that has good pharmacy coverage for immunosuppressant medications (especially tacrolimus) I’m all ears.
Big Picture Pathologist
Thanks for the reminder.
I was ready to keep my UHC/AARP but they collaborate with Walmart for prescriptions and pulled that stunt about threatening to not cover ER visits for ‘unacceptable reasons.’
If anyone has a plan they’d like to recommend that has good drug coverage, especially for immunosuppressant meds, I’m all ears.
I have a question about Medicare Part D prescription drug plans (PDPs). That’s a little off the topic for today but related. I am now taking valsartan, which is Tier 1 or 2 on most plans, and thus cheap, but happens to be Tier 3 on my plan, and thus moderately expensive. (For some reason my plan wants to steer everyone to the similar losartan, which would probably be okay, but I don’t feel dancing to the company tune on something serious the way I would for something like a different PPI.) When I started shopping, I found radically different premiums for different plans despite terms that seem very similar. If I just looked at the drugs my wife and I take, there was very little difference between a $12 plan and an $85 plan. Moreover, most plans seem to have a $480 deductible which is not applied to Tiers 1 and 2, with maximum out-of-pockets and co-pays for higher tiers that are often similar too. There must be some kind of major differences. Are they basically hidden in the formularies? I want to do what is best not only for the drugs we are actually taking, which are the usual old folks’ stuff, but for possible needs should one of us actually need something expensive in the next year. How does one shop for contingencies? A retired doctor friend of mine, who has a chronic condition that requires hundreds of dollars a month in drugs, says that it is hopeless to select on that basis. Just go for what’s best given what you take now, he says, and cross that bridge if you come to it.
@PST: Medicare Part D is a morass of choice for the exact reason that you mention — the drivers are in the formularies and not the topline/visible numbers. GET HELP!
Medicare offers a choice support tool: https://www.medicare.gov/plan-compare/#/?lang=en&year=2022
The State Health Insurance Assistance Program is also a good free resource to talk to an actual person: https://www.shiphelp.org/
@David Anderson: Agreed on the GET HELP, but I question whether the help needed to make decisions about future risk is available. I have used the Medicare tool, which is great as far as it goes. You enter all your medications and it lets you compare plans. I have talked to various brokers about plans, and it seems to me that all they do is enter information into the Medicare tool, or a proprietary equivalent, and tell you the same thing. My worry is about how you compare plans for future needs involving drugs you don’t need now but might need before the end of the year. The universe of possibilities is almost endless. Will I need chemo? Will I have a transplant and need immune suppressing drugs? I just have no idea how to make an informed choice that takes into account more than my current needs, and nothing I found on the internet or talking to medically sophisticated friends helped much.
Big Picture Pathologist
Thanks for the links.
@PST: You’re SOL on trying to predict future uncertainty with these tools.
David, have you read/heard any feedback regarding OSCAR, a relatively new health plan created and owned by those wonderful (blech) venture capitalists (and a Kushner to boot). Argh!
We want to stay with our state university health system (University of Colorado). Last year, there were no plans on the exchange that offered access. (We were lucky and were on Cobra until this month, so we’ve got a bridge catastrophic plan to get us to January.)
For 2022, we will be able to choose from Anthem or OSCAR to access the UC Health system. My husband has a giant spreadsheet and is analyzing both options. Anthem is, well, Anthem. But OSCAR is an unknown. Any thoughts? OSCAR is new to the Colorado marketplace and appears to be targeting younger people, and we don’t fit into that demographic…
Thanks so much!
@martha: OSCAR is a VC funded insurance company that recently went IPO on the public market. It’s theory of change is that it can collect plenty of patient reported outcomes and intermediate process steps because it has a wicked cool app that gets people to sign-in every week and give them information. This information is then blended with traditional claims data where advanced stats are applied against the blended data to find ways to either improve health and/or lower costs. Most of its marketing to date has been on <40 crowd.
I have been following OSCAR since 2013 and I am still skeptical that they are doing anything that is fundamentally different (besides consistently lose money) than many other health insurers, but those health insurers are actually able to do it at scale (100,000s of lives per year per state) instead of artisanal big data collection. From what I’ve heard, they’re fine, if anything it is a nice customer experience, and claims will get paid but they aren’t doing anything different besides have a nice customer experience while avoiding a significant amount of risk.
@David Anderson: David, thank you so very much for your response! I am under no illusions from a data perspective. Of course Anthem does the same thing. But they do have more of a track record for dealing with our demographic (not to Medicare yet, but I’m getting closer.) We will see what my husband’s magic spreadsheet kicks out. As of right now, we’re leaning towards Anthem but he’s going to tweak it more to try to get the best “apples to apples” comparison.
Who would be the right help for the state of Washington? I get frequent messages with useful links and tips from CoveredCA, which would be great if we still lived there. :-)
(We’re currently on a Kaiser plan through the WA state thing as we still aren’t quite old enough for Medicare. We—spouse and I—are both currently retired, but that could change next year, perhaps. Current income means we qualify for subsidies; if I become employed, I’ll probably wind up with employer coverage, which will throw everything out the window, sigh.)