Don’t wait to get ACA plans
Don’t procrastinate. That’s the advice counselors have for consumers shopping for Affordable Care Act health insurance plans this open enrollment season.
The sign-up period for ACA plans began Nov. 1. As was the case last year, the time in which consumers have to enroll is only six weeks. That’s down from 12 weeks in earlier years. Enrollment ends Dec. 15.
“Don’t put it off and wait until the last minute,” said Sandra Clark, a certified application counselor with Family Christian Health Center based at the health care provider’s Harvey site.
If help is needed in enrolling, call right away to make an appointment with a navigator or certified application counselor who can help in choosing the right plan, Clark said.
Federal funding for navigators was cut nationally this year to $10 million, down from $36.1 million last year and from $62.5 million two years ago. In Illinois, funding has been sliced to just over $389,000 from nearly $1.8 million in 2017 and from close to $2.6 million in 2016.
In announcing the funding reductions earlier this year, the Centers for Medicare & Medicaid Services said it’s pursuing a more cost-effective approach to the navigator program that takes
better advantage of volunteers and community partners.
Statewide, the number of navigators and certified application counselors licensed in Illinois remains consistent with last year, according to the Illinois Department of Insurance.
But those who counsel consumers worry the funding cuts will have negative repercussions.
“I think it’s going to be harder for people to get in-person assistance,” said Karen Pollitz, senior fellow with the Washington, D.C.-based health policy nonprofit Kaiser Family Foundation.
“I think we’re all concerned about that,” said Jan Dowers, who is working as an ACA enrollment specialist at the Planned Parenthood of Illinois Flossmoor Health Center. “But we’re all committed to working as hard as we can to help as many people as we can.”
Planned Parenthood of Illinois received a $208,000 grant to fund three navigators in Cook and Kane County, she said.
Despite the fact that the ACA program is now in its sixth year, many people still need help in purchasing insurance through the so-called ACA marketplaces or exchanges, Clark said. Indeed, surveys of ACA marketplace assisters have consistently found that consumers seeking help had limited understanding of the eligibility and enrollment process and lacked confidence to apply on their own, according to the Kaiser Family Foundation.
“It’s complicated particularly if you’re applying for subsidies or if you have other kinds of complications like maybe you work seasonally or are selfemployed,” Pollitz said.
For those for whom English isn’t their first language, it can be particularly difficult to navigate the process on their own, she and others said.
Reduced marketing funding this open enrollment period compared to year’s past also is sparking worries that will be a barrier to people enrolling. The state has provided $1 million in funding for education and marketing this year mirroring last year, according to Illinois Department of Insurance Director Jennifer Hammer. But that compares to $5 million in federal funding that was available two years ago.
“That affects outreach, how wide you can cast the net,” Clark said. “Surprisingly, even after all these years, still so many people are not familiar with the ACA and the opportunity to get insurance. Every year, I’m stunned by how many people don’t know about it.”
In Illinois, 356,403 people enrolled in ACA plans for 2017. That fell to 335,000 for 2018.
“We are optimistic the enrollment will remain steady this year,” Hammer said.
Some premiums have fallen this enrollment period. Average rates for the 2019 lowest cost silver ACA plans declined 4 percent from last year, and the lowest cost gold plans slid 6 percent, according to the Illinois Department of Insurance. But overall rates for the lowest cost bronze plans rose 6 percent. Still, that was less than last year’s 20 percent rise.
Nationally, about 85 percent of people enrolled in the plan qualify to receive subsidies or tax credits to lower premiums, according to an Illinois Department of Insurance spokeswoman.
In Illinois, consumers can purchase insurance for coverage that begins Jan. 1, 2019 on the Get Covered Illinois website, the official ACA marketplace in the state, at getcovered.illinois.gov. Consumers also can search for options by zip code to find local, free application help and schedule appointments for assistance on the site. Help also is available by calling 866-311-1119.
When seeking help, among information and documents needed are Social Security numbers of each family member, citizenship documents, proof of income for the most current 30 days and expectations for your annual income next year, Dowers said.
When weighing purchasing options, factors to consider include “what can you afford per month for the monthly premium in addition to what is the overall out-of-pocket expense, copays, deductibles, any cost sharing,” Clark said.
“People who have established medical treatment from a particular doctor, specialist or hospital want to make sure that the plan covers your established health care provider.”
Consumers should check to see if they are eligible for subsidies or tax credits, Pollitz said. She and others also advised consumers looking at less expensive short-term plans, which some companies are marketing as alternatives to Affordable Care Act plans, proceed with caution.
Indeed, the Illinois Department of Insurance has put out a buyer’s guide to inform consumers. The guide notes that unlike Affordable Care Act plans, short-term plans don’t require mandatory coverage of essential health benefits, which include such things as hospitalization, prescription drugs, emergency care and rehabilitation services. The short-term plans also aren’t required to cover pre-existing conditions, mental health services and substance abuse treatment, which ACA plans are required to cover. So for consumers considering such plans be crystal clear on what they do and don’t cover.
Sandra Clark, left, a certified application counselor with Family Christian Health Center in Harvey, speaks with Eboni Mearieweather about Affordable Care Act open enrollment.