As Obamacare open enrollment kicks off on Nov. 1, anyone in the market for an individual health plan is facing a tough road. With insurers like Aetna and Humana ditching the insurance exchanges created by the Affordable Care Act, nearly one in five marketplace shoppers may find just one carrier offering plans in their area, according to the Kaiser Family Foundation.
In late October, the Department of Health & Human Services reported that premiums for the benchmark silver plans sold on the federal and state marketplaces will go up 22% on average in 2017. Premiums averaged $396 a month on Healthcare.gov in 2016. To find affordable coverage, take these steps.
Get full credit
You can buy a plan on the federal and state-run marketplaces (find yours at Healthcare.gov) or privately. But if you qualify for a tax credit—available to individuals earning $47,520 or less or a family of four making up to $97,200—you’ll need to shop via the marketplaces to collect.
Those subsidies can offset higher costs since they are tied to plan premiums and your income, but not everyone who can benefit does. In October, the government reported that some 2.5 million people are missing out on subsidies by not shopping on an exchange.
If you do qualify for a tax subsidy, stay on top of your income as the year goes on. Louise Norris, co-owner of the Colorado Health Insurance Insider brokerage, says a common mistake people who file for subsidies make is “forgetting to keep the exchange updated on income changes throughout the year, and then having to pay back more than expected at tax time.”
If you’re sure you won’t qualify for a subsidy, also shop outside the marketplaces, where you’re likely to find more choice. At insurance broker eHealth.com, in 15 states, including California, at least three insurers will offer plans that they won’t be selling on the exchanges; in another 28 states, at least one insurer will.
You may be able to get past another exchange-plan problem: narrow doctor networks. A McKinsey study of 2017 exchange plans in 18 states and D.C. found that 75% will be HMOs or EPOs, both of which restrict you to a limited network of doctors and hospitals.
Turn off autopilot
If you have an exchange plan and are among the nearly 2 million people whose insurer will no longer offer coverage for 2017, select a new policy by Dec. 15. Otherwise, the exchange may do it for you. Shop anew even if your insurer is staying put—the carrier that was the best value in 2016 won’t necessarily be tops in 2017. Open enrollment runs until Jan. 31.
You can find insurance brokers certified to sell both on and off the exchanges at localhelp.healthcare.gov.
Look past the premium
You may have a choice of platinum, gold, silver, or bronze plans, and shouldering more out-of-pocket costs with silver or bronze can cut your premium. But even within those tiers, deductibles and out-of-pocket limits can vary. “It’s very challenging for people to understand what that means for them,” says Sara Collins, vice president for health care coverage and access at the Commonwealth Fund.
To do a worst-case scenario calculation, add your annual premiums to your out-of-pocket max. The calculators at Healthcare.gov can help you dig deeper on costs.
In addition, more than 60% of ACA plans don’t cover prescriptions until you meet your medical deductible, says Nate Purpura, vice president of communications at eHealth. Check each plan’s drug formularies. “Your best chance of saving money is to make sure your prescriptions are covered,” says Purpura. “That’s the biggest area other than the provider network where you can manage costs.”