Obamacare enrollment 2018: These are 5 things you need to know

Oct. 30--WOODBRIDGE -- "I need insurance," said Stavrova, 39, of North Arlington.

Open enrollment for the Affordable Care Act, or Obamacare, begins Nov. 1, giving consumers who don't already get insurance through their employer, Medicare or Medicaid a chance to find health coverage in 2018.

It marks the first signup since the law's architect, Barack Obama, left the White House, and it caps a tumultuous year. Newly elected President Donald Trump and the Republican Congress have spent much of the past 10 months trying to dismantle it.

The law remains in place, a sign that the health care industry is so complicated that even a tiny change can create unintended consequences, unraveling the entire system.

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More: Fewer in NJ have no health insurance; will it last?

But the ACA's new managers aren't fans. On the healthcare.gov website, where individuals can sign up, is an unenthusiastic endorsement: "We're going through every page of regulations and guidance related to the Affordable Care Act to determine whether or not they work for patients."

"Since the ACA came out ... this is the most turbulent year in the marketplace," said Michael Considine, a Horizon vice president. "And who is going to win in this marketplace, especially this year, is the company that is able to demonstrate stability, eliminate confusion and provide value."

Where does that leave consumers for 2018?

Here is what you need to know:

1. The basics

Obamacare is available to consumers who don't get health insurance through Medicare, Medicaid or their employer.

Last year, 289,000 residents signed up through the exchange, which amounts to about 4 percent of the overall health insurance market, according to the New Jersey Association of Health Plans, a trade group.

New Jersey this year has three insurers selling policies in the exchange: Horizon, AmeriHealth New Jersey and Oscar. That's up from two last year.

The Trump administration shortened open enrollment to Nov. 1 through Dec. 15. And the insurance exchange will be shut down for maintenance midnight to noon every Sunday except Dec. 10, Kaiser Health News reported.

More: Oscar plan comes back to NJ Obamacare for 2018

2. The Trump effect

Trump ended cost-sharing payments to insurance companies that lowered out-of-pocket costs for low-income consumers.

And he has said he won't enforce the so-called individual mandate that forced uninsured consumers to pay a tax of 2.5 percent of their household income, or $695 per adult and $347.40 per child under the age of 18, whichever is more.

Insurers said the moves increased premiums. Horizon, for example, said it was in line for a single-digit increase, but instead needed to raise average rates more than 16 percent.

A middle-of-the-road silver plan for individuals will cost on average $311.86 a month for AmeriHealth New Jersey; $346.72 for Horizon; and $349.30 for Oscar, before taking subsidies into account.

More: Trump's health care order: Can it make NJ insurance cheaper?

More: Horizon, AmeriHealth raise NJ Obamacare prices after Trump moves

3. Shop around

Peggy Frayne, 59, of Brick, said she got notice from Horizon that premiums for a policy covering both her and her husband are set to increase from $442 a month to $795 a month, after taking subsidies into account.

She plans to look at her options, a task that will get her up-to-speed again on fancy insurance terms.

"I'll have to go in, see what's available and, if I can find the same plan with a higher deductible, I'll do that," she said.

Key terms consumers should know:

* Premiums are the cost of health insurance.

* Co-payments are a flat dollar amount paid to the provider at the point of service.

* Deductibles are what consumers pay out of pocket before insurance kicks in.

* And coinsurance is a percentage consumers can pay after they reach their deductible.

Younger, healthier consumers might consider choosing plans that have lower monthly premiums that come with higher deductibles.

But going without health insurance altogether is a risk. One visit to a hospital emergency room can run into the thousands of dollars.

With a few exceptions, consumers can't buy health insurance outside of the open enrollment period. If they wait until they get sick or injured, they will be out of luck.

"It could lead to financial ruin very fast," said Toby Stark, past president of the New Jersey Association of Health Underwriters and a Tinton Falls-based broker. "If everybody knew what was going to happen, there would be no need for this."

More: RWJBarnabas CEO: Hospitals must accept less money for better health

4. Know your tiers

Add one more term into the mix: tiered networks.

Horizon's Omnia plan features a tiered network in which consumers pay less if they go to what is known as a Tier 1 provider. They can go to a Tier 2 provider, but they would pay more.

The plan caused an outcry from state lawmakers and sparked a lawsuit from Tier 2 providers. But AmeriHealth New Jersey appears to be following suit. Its Advantage plan also has tiers.

In both plans, RWJBarnabas Health and Hackensack Meridian Health are in Tier 1. CentraState Medical Center in Freehold Township, the sole hospital in Monmouth and Ocean counties that is not part of those chains, is in Tier 2.

More: Horizon push is keeping people out of hospital

5. Free help

The Trump Administration cut back its marketing, leaving health insurers and consumer advocates to try to get the word out.

Horizon has vans on the road and kiosks in malls. And it set up a concierge system, giving customers the name and photo of a Horizon representative they can reach with questions.

AmeriHealth New Jersey said it is sending Mini Coopers on the road and calling and texting customers about renewals.

And Fulfill, formerly known as the FoodBank of Monmouth and Ocean Counties, will enroll consumers at its Neptune headquarters and libraries and town halls regionwide. For more information, call 732-643-5888.

"It is an important step to making sure we have a healthy community," said Carlos Rodriguez, Fulfill's executive director.

Michael L. Diamond; 732-643-4038; [email protected]

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