Open enrollment for ACA
Open enrollment for Arizonans who buy health insurance on the Affordable Care Act marketplace is underway and continues through Dec. 15.
Open enrollment for Arizonans who purchase their health insurance on the individual Affordable Care Act marketplace started Thursday.
This year’s sixth annual Affordable Care Act enrollment goes through Dec. 15 for insurance that begins Jan. 1, 2019.
ACA open enrollment should not be confused with Medicare open enrollment, which began Oct. 15 and goes through Dec. 7.
Most Arizonans don’t get their health insurance on the Affordable Care Act, or ACA, marketplace. As of February 2018, nearly 11 million Americans, including about 155,000 Arizonans, had ACA plans, federal data shows.
The health-insurance marketplaces, sometimes called exchanges, were created by the ACA (also known as “Obamacare”) to offer insurance plans to working-age individuals and families who are not covered by other insurance such as Medicaid or employer-sponsored coverage.
While some states operate their own exchanges, Arizona uses the federally facilitated marketplace, which operates via the website healthcare.gov.
Here are five things to know: 1. More insurers are in the marketplace this year, though 13 of Arizona’s 15 counties still have only one choice.
Blue Cross Blue Shield of Arizona will be the only insurance company selling plans in most Arizona counties this year, and will be selling plans in all counties except Maricopa.
Residents of Maricopa and Pima counties will have more choices this year, with four insurance companies selling plans in Maricopa County and three in Pima County.
In Maricopa County, the choices are Minnesota-based Bright Health; New York-based Oscar Health; Pennsylvania-based Cigna Health Insurance; and Tempe-based Ambetter from Arizona Complete Health (owned by Missouribased Centene Corp.).
For 2018, only Ambetter, formerly called Ambetter from Health Net, offered ACA plans to Maricopa County residents. Ambetter also was the only choice for Pima County residents in
2018.
The three companies that will be selling plans in Pima County are: Blue Cross Blue Shield of Arizona, Bright Health and Ambetter from Arizona Complete Health.
2. Don’t pay for help. Free help is available.
Consumers should never pay to get help enrolling. For free local help in enrolling in the marketplace, Arizona consumers may call 1-800-377-3536 or go to www.coveraz.org
Cover Arizona can also help people figure out whether they or their family members qualify for Medicaid, a government insurance for low-income people that in Arizona is called the Arizona Health Care Cost Containment System.
Some adults may not qualify for AHCCCS, but their kids could qualify for an AHCCCS program called KidsCare. Enrollment assisters can help figure that out, too.
An alternative is to go to an insurance broker, who also will not charge a fee, go directly to the company selling the plans, or go directly to healthcare.gov (phone number is 1-800-318-2596). Healthcare.gov can also recommend brokers.
“You should never pay anyone to help you enroll in insurance,” said Allen Gjersvig, director of navigator and enrollment services at the Arizona Alliance for Community Health Centers.
3. People who don’t think they can
afford to buy insurance on the marketplace should run the numbers on healthcare.gov anyway — it may be more affordable than you think.
Most Arizonans who bought ACA insurance in 2018 qualified for federal subsidies to help pay for it, and premiums this year will on average either stay the same or decrease from 2018.
“At least go to healthcare.gov and preview your options,” said Marcus Johnson, director of state health policy and advocacy for the nonprofit Phoenixbased Vitalyst Health Foundation.
Johnson said people often talk to neighbors and relatives without actually checking plan costs themselves, and people may be pleasantly surprised.
A preview of 2019 plans on healthcare.gov shows a 35-year-old non-smoking female in Maricopa County who earns $28,000 per year could get coverage ranging from $88.94 per month to $503 per month, depending on the type of plan she purchases.
In another example, a single, 48year-old non-smoking Maricopa County father of two children under the age of 18 earning $30,000 per year would qualify for a family plan that has no monthly premium.
Costs go up significantly, however, when consumers earn too much money to qualify for a federal subsidy.
A single, 56-year-old female nonsmoker in Yavapai County earning $55,000 per year would not qualify for a federal subsidy and the choices are costly, plan previews show, with monthly premiums starting at $909.12.
Gjersvig said Yavapai County is one of the highest priced counties for ACA plans. For people who earn too much to qualify for a federal subsidy, the costs for insurance can be prohibitive. He said someone in that situation would be best advised to go to a broker, which doesn’t cost anything, to figure out whether there might be off-marketplace options that are more affordable.
4. There are no federal penalties for being uninsured, or for buying a short-term plan, but weigh the options carefully.
“People have to make the best decision for themselves and their families when it comes to health insurance,” the Vitalist Health Foundation’s Johnson said.
“It’s better to have it and not need it than to need it and not have it. If you go without coverage and heaven forbid have a heart attack, that could be $24,000 or $25,000.”
People with otherwise excellent health can and do have unexpected health events, whether it’s an illness such as cancer or an unanticipated injury.
“You are taking a risk, whatever your reason,” said Gjersvig of the Arizona Alliance for Community Health Centers.
Another problem is that when rates of people without insurance go up, uncompensated care goes up, too, and that impacts the whole health system.
One option for healthy people looking to save money is to look at a shortterm plan, but such plans can be limited in what they cover. Such plans can exclude people with pre-existing conditions, and often exclude the benefits that ACA-compliant plans are required to cover, such as behavioral health, prescription drugs and maternity care.
But short-term plans do not offer the same coverage Americans have grown accustomed to under the ACA, Gjersvig said.
The Kaiser Family Foundation on Wednesday released a report that says short-term health-insurance plans present a trade-off to consumers — lower premiums in exchange for more limited coverage and less protection than ACAcompliant plans.
“The lower premiums will likely prove attractive to people who are healthy, especially those buying their own coverage now who have incomes too high to qualify for ACA premium subsidies,” the report says.
“If such individuals opt for shortterm plans and then become seriously ill or injured, however, they could face higher out-of-pocket costs.”
5. Read the fine print of any plan you buy and look to see whether your doctor or hospital of choice is in-network.
A plan may have a low premium, but the annual deductible is $7,000. Someone with a chronic health condition may opt to pay a little more per month to lower their out-of-pocket costs for care.
Also, make sure to check whether the plan you are buying includes your doctors and hospital of choice as in-network.
“If you currently have a marketplace plan, both healthcare.gov and your (insurance) company will send you a renewal. But we encourage people to actively shop for plans,” Gjersvig said. “And shop before you buy.”