The Affordable Care Act’s Open Enrollment Period begins today. Individuals must sign up by 11:59 PM PST December 15. 2023 to have an ACA policy that starts on January 1, 2024. Almost every state on either Healthcare.gov or their own marketplace will run open enrollment through at least part of January. Open Enrollment is when individuals and families can pick a plan or switch plans for any reason at all without any paperwork or qualifying event.
The big thing is that picking plans is tough. If you made a perfect last year, you still should be looking at your options this year. Plan offerings change, and given how subsidies work in the ACA, doing nothing with this year’s plan could lead to a big unpleasant price surprise in January. If you are currently enrolled in the ACA, look around at your options and figure out what you value and what fits with your values, preferences and priorities.
If you are new to the ACA, take your time. Picking a plan this week versus next week won’t get coverage started any earlier or any cheaper. Acknowledge that this is a confusing choice space. Acknowledge that for most folks, this is a pick against a portfolio of predicted futures. This is not easy, so take your time and get help. Most people get help from brokers, agents and/or navigators. The Biden Administration has buffed up navigator assistance to help people figure out this messy set of choices.
Let’s talk in comments as you run into challenges.
Urza
As I contemplate early retirement, I was looking for healthcare plans. Is there no such thing as a private plan that actually covers 100% of everything after some deductible? Even 10% copay on a platinum ACA plan could really add up with even 1 hospital stay.
schrodingers_cat
What are the options for health insurance for someone who is traveling to the US on a visitor visa if they are elderly.
billcoop4
Of course, New York opens its exchange on 11/15 from what I see.
BC
Winsomeone
David, do you know if one who did not meet minimum income requirements previously will now be able to sign up for a well-subsidized plan with the Medicaid expansion in NC? Also, does a person have to have full-time employment to qualify for it?
narya
I have Medicare plus a supplemental plus a drug plan; as best I can tell, if I do nothing, I stay with what I have. Yes?
Why would my drug plan drop from $8/month to $0? (I don’t take any meds right now.)
WhatsMyNym
@schrodingers_cat: They would need travel insurance. I found 2 reviews from known sources and they both list the same companies; Forbes Advisor and at Nerd wallet.
schrodingers_cat
@WhatsMyNym: Thanks, I know, I also have some quotes. I was wondering if our BJ insurance expert had anymore insight.
Miss Bianca
Just made an appointment with my insurance broker.
WaterGirl
@Winsomeone: Welcome! I approved your first comment, so now your future comments will show up for everyone right away.
Betsy
For anyone here that is choosing a plan —How to get an excellent, low-deductible plan for zero premiums:
1. Plan your income to be around 24,000. This is low enough to get about the maximum premium subsidy , but high enough to qualify for the premium subsidy. In my experience, if you dip below 18,000 income, you lose the subsidy and end up paying a lot more in premiums.
READ NEXT STEP to understand how to maintain a decent income but still have it at 24,000 for subsidy purposes: esp if you are self-employed but possibly in other situations.
2. To reduce your income and avoid falling off the subsidy cliff — put as much as you can into tax-advantaged retirement accounts.
So if you have an IRA and other retirement accounts, and make 50,000, jam 22,000 into those accounts in 2024, and you have magically reduced your income to 28,000 for ACA subsidy purposes. (Be aware of IRA contribution limits and limits for other accounts)
This assumes you can survive without the money until you are age-eligible to start taking it out of your IRA.
Meyerman
“The big thing is that picking plans is tough. If you made a perfect last year, you still should be looking at your options this year. Plan offerings change, and given how subsidies work in the ACA, doing nothing with this year’s plan could lead to a big unpleasant price surprise in January.”
I understand that this is reality, but how does this make any sense? When I was at the U of C, I learned that markets are perfect, but that even perfect markets can fail given imperfect information. Your depth of knowledge on these markets is 5 sigma or more greater than the average purchaser on the ACA markets. How can we even pretend that Joe or Jane average has a fighting chance at picking the best or even the not worst plan? Plus, in most years, my mistake in buying insurance are a sub-thousand dollar hit, but when I lose the lottery, my mistake becomes a $100,000 hit. How can I even begin to decide how much to invest in making my plan choice?
Betsy
@Urza: the very lowest deductible and zero co-pays comes with the plants that are 100% subsidized way down at the lower end of the income scale. (Between 18,000- 24, 000)
The best insurance I ever had was through the ACA when I made about $22,000 and qualified for a zero premium, $300 annual deductible, $0- $10 co-pay plan.
Betsy
@Meyerman: yes, exactly. Like everything else in this stupid country, it’s designed to inflict suffering and risk on even people who carefully make hard choices.
We just love suffering for Americans – it’s definitely seen as a feature, not a bug
Ruckus
@Betsy:
Don’t we suffer for someone else’s advantage? Doesn’t everything even out in the wash?
My point is that in a capitalistic country the point is to make money to live and the vast majority of us don’t make huge amounts. Most of us do OK, some better, some worse, some not much at all, and too many – not really OK. And OK is different for most of us. Also OK is not the same as great. But for most of us, we learn to accept OK, because it is, well, OK.
Almost Retired
Last year and this year I made an in-person appointment at Covered California (I’m self-employed and my wife is retired).
The experience was terrific. The agents were well-informed and seemed to fully understand the products they were evaluating – and were good with strategizing about income and subsidies (IRA, etc). I felt like I got a lot more individualized attention in person than when I speak with telephone representative.
On one hand, I’m sort of bummed out that we’re not yet eligible for Medicare. On the other hand, I’m not at all bummed out that we’re not yet old enough to be eligible for Medicare….
David Anderson
@Urza: ACA plans have an out of pocket limit that will stop-loss all cost-sharing. Higher AV plans like a Platinum plan tend (not always, but tend) to have lower out of pocket limits than lower AV plans like a Bronze plan.
David Anderson
@Winsomeone: Individuals who earn under 138% FPL and who are not otherwise qualified for Medicaid will become eligible for Medicaid in North Carolina effective 12/1/23. There are no asset tests nor employment requirements for this coverage. The premium is $0 and cost-sharing is de-minimas (never more than a $4 copay). The biggest tripping point is that eligibility is based on the eligibility rules in effect the day the application is processed so an Expansion only eligible individual will be denied if they apply in November but will be approved if they apply/application processed in December. There is retroactive coverage available if needed.
North Carolina Department of Health and Human Services has a good FAQ:
https://medicaid.ncdhhs.gov/questions-and-answers-about-medicaid-expansion#:~:text=You%20do%20not%20have%20to,only%20required%20for%20some%20services.
David Anderson
@narya: Unless the insurer is leaving your geographic service area, doing nothing keeps you locked in (minor variations apply if your insurer for the drug plan replaced plan 12412 with plan 12499 etc.)
Lots of things could move your premium +/- $8
David Anderson
@schrodingers_cat: outside the realm of my expertise. Talk to an agent!
David Anderson
@Meyerman: Don’t expect optimality retrospectively or prospectively.
Look for good enough to be good enough.
Yeah, I consider myself to be way too into the weeds of the ACA, and I am convinced that if I had to pick a plan for my family tomorrow for 2024, retrospectively, I am unlikely to pick an optimal plan. I am very confident that I will pick a pretty good to very good plan retrospectively and prospectively, it will be a pretty damn good plan.
My main hope is that we can collectively avoid choosing the truly shitty and objectively dominated plans.
Gusnite
This is so timely. Our 25-yr-old son turns 26 tomorrow and his insurance from my employer ends. Can he sign up thru ACA but start coverage when his current coverage ends?
Further complication: he has serious liver disease and has had two hospitalizations in the past year and needs regular procedures (endoscopies). My work plan was excellent and he was well covered but we are afraid we will choose poorly and he will not have adequate coverage. The insurance agents in our lives do things like auto, life, and homeowners. How do we find expert advice in the arcane field of health insurance?
PS – apologies David, I read quickly and not well. Sounds like we should start with a ‘Navigator’ to help us, unless someone thinks that owing to the unusual pre-conditions it might be better to rely on broker or agent?
Thanks!
Betsy
@Ruckus: Seriously? Fuck that noise. Why would the Swiss impose that on any Swiss person? The French, the Danes, the Spaniards — they don’t inflict suffering on their own people through fucked-up policy choices.
But Americans? “IGM, FU”! (until of course the IGM guy gets his face eaten by the exact same leopard that ate everyone else’s face, then there’s screaming and probably some immigrant-blaming just to make things right)
David Anderson
@Gusnite: Since your son is losing eligibility at the end of the month of his 26th birthday, he gets a special enrollment period that would carry him through the end of the year.
Yeah, go talk to an agent or a broker. This is a complex case and good help is needed.
Juice Box
Bwahaha! I’m just letting it roll over because a few months into the year I will be eligible for the big MC! I’m less enthusiastic about being old, though.
Gusnite
@David Anderson: MANY THANKS!
Appreciate it, really.
Ruckus
@Betsy:
I think we actually agree, maybe I just didn’t state it so well….
Our economic system is based upon there being a profit. Now the government only really worries about breaking even so that helps. But because breaking even is the goal, sometimes things fall through the cracks. And a democratic government likes to repair the cracks so things work better, a rethuglican government thinks only of their profits.
And a profit has to come out of someone’s pocket, so in countries that subsidize/control the cost of at least normal medical care and provide either coverage or actual medical care the cost is controlled. In a free(ish) country like ours we sort of have healthcare costs controlled by providing some degree of leverage on costs with competition and government programs like ACA. But. In a free(ish) country, based upon everyone making a profit, costs will be higher.
My question is, should at least basic medical care be provided by open competition with a undisclosed profit margin or by control of the government? In our country it is open competition with very little to none in cost control. Now I can’t actually complain because I have medical care provided by the VA. But even on SS as my only income, I do not qualify for totally free medical care. After a full calendar year of retirement/SS income only I pay for prescriptions. If I had been in combat I would pay less or nothing for them.
My point is that most of the citizens of this country pay a lot for healthcare or get minimum or – don’t get any. I think that we should do better, in several ways. First, tax the rich more. It wouldn’t have to be a lot to make a significant difference. Second, should we think about providing healthcare for the indigent? I’d say YES. Third, could we do better? I believe we could if we took profit out or at least controlled it’s level so healthcare costs would not be such a burden on the citizens. I don’t have any plan to get there but I think we should consider something, somehow and at least make an attempt
Plus, out of 330 million people I’d bet there are more possible humans who could be medical personal of all levels, so that we could provide more care to more people at a better price. I could be wrong.
Betsy
@Ruckus: To my mind, you are not wrong.
Case Crum
As someone who is in the gap (Too poor for the subsidies, live in a non-expansion state)? I fail to see how the ACA really does anything except make things slightly less complicated. Just another way Alabama is a hellscape. Still wish President Obama hadn’t let the ACA get watered down, and had fought SCOTUS allowing states to opt out.
Ms. Deranged in AZ
I got a plan a couple of months ago (United Healthcare Silver Advantage Plus) mainly because it said it covered Adult and child dental (plan is for myself and my 13 year old son) and it was a good price for that coverage (after subsidy was applied because I’m unemployed). So I took him to the dentist for his 6 month cleaning and they said that the plan only covers children 19 years of age and older. I was so angry…a 19 yo is not a child…they’re an adult dependent. So now I have to pay cash for frigging standard dental work for my son in addition to out of pocket for his braces because none of the plans cover orthodontic work (unless it’s medically necessary). My dentist said several other families ran into the same thing. That the “child” dental coverage was buried in the very fine print and no one realized it until it was too late. So now I will have to change plans yet again, I guess. But how can they get away with this? I mean, the website makes you enter birthdates and it never warned me that the child dental would not actually cover the one and only child on the plan!!!! Unless my dentist was wrong? But they are usually very good about such things and they said it had affected others as well.