The majority of group health plans, as well as individual health plans, have open enrollment in the fall. So now is the time to pay attention to your benefit options.
If you are enrolled in an individual health plan in rural Northern California, you will be facing rate increases from 17 percent to 50 percent. However, those receiving subsidies under the Affordable Care Act, (ACA, also known as Obamacare) will likely see the subsidy increase resulting in little increase in actual premiums. The health insurance company tax of 3.3 percent is a one-time adjustment included in these rates. If you have a child who turned 21 this year, you will experience the standard increase from child to adult rates.
Individuals covered on or off the Covered California exchange will soon receive a notice regarding their plan options. If you are in a plan being eliminated, there may not be automatic “mapping” to a comparable plan, so action is required. Read your letters carefully.
The insurance companies have until Sept. 30 to file final rates so we won’t know exact rates until October. The political uncertainty about the ACA has created major problems in the individual markets.
One of the foundations of the ACA is “guaranteed issue,” meaning that the insurance company cannot deny coverage and no pre-existing condition limitations can be applied. In order to make this possible, a mandate requiring everyone to have coverage with limited open enrollment dates was included. Otherwise, folks would wait to buy insurance until they became ill.
With constant talk about repealing the law, insurers simply do not have a clear picture of the rules under which they are to set rates. The ACA allows cost sharing reduction subsidies that provide enhanced benefits to those lowest income consumers. About 60 percent of the enrollees in our state have subsidies. The Trump administration is deciding monthly whether the subsidies will be continued or not, which creates a real problem for the actuaries. Without the federal support from the subsidy payments, the enhanced Silver plan rates need to increase by about 20 percent to 25 percent.
Fortunately, we live in California where we have one of the most successful exchanges in the nation. We also have the second healthiest risk profile in the nation according to Covered California.
While the federal open enrollment period is Nov. 1 to Dec. 15, California will extend its to Jan. 31. I have mixed reactions to this. In my experience with open enrollments, most consumers wait until the last minute to address the situation. I guess it is human nature.
Covered California has indicated it will auto-renew consumers who are eligible. While this simplifies the process, it can create unwelcome surprises for the consumer who has not looked at costs, plans and networks for the coming year. At least they will have until Jan. 31 to make changes.
I recommend that all insureds, whether group or individual, take the time to carefully review their open enrollment information. Look at the plan networks and benefits. Covered California will have an online provider search tool starting in October. This site includes a tool that allows consumers to see an estimate of costs for different plan options based on their expected income for 2018. It should be available early in October after rates are finalized. You can check it out now at www.coveredca.com and click on “Shop and Compare” to practice now.
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Read More: http://www.redding.com/story/money/columnists/margaret-beck/2017/09/12/open-enrollment-season-here-soon/657770001/