Open enrollment for health insurance is here, even with much confusion

Despite months of rancor on Capitol Hill and President Donald Trump's own declaration that Obamacare is "dead" and "gone," the Affordable Care Act remains in place.

And right now, it's sign-up season.

Shoppers only have one month left before the first - and possibly most important - deadline to purchase coverage for 2018. And while signing up for the right plan has always been complicated, experts say this year's sign-up season can be particularly confusing.

"It's unfortunate that the national debate we're having here probably muddied the water more than it's done to clarify anything," said Joe Hanel, a Colorado Health Institute spokesman. "It's a confusing product to buy - it's not an exciting product to buy. There's a lot of consumer education that needs to happen."

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Officially known as open enrollment, the sign-up period opened Nov. 1 and marks the one time for individuals to buy health insurance or switch plans without also experiencing a major life event, such as having a baby, getting married or getting divorced.

The constant headlines about congressional efforts to repeal and replace Obamacare have left many unsure if the law remains in place, experts said. Added to that confusion, Trump has made statements suggesting the individual mandate be repealed (it hasn't been).

Trump also has cut federal outreach funding that, in the past, urged people to get signed up. And shoppers have far less time to shop this go-around than in years past.

Still, daily enrollments are up across the nation.

More than 150,000 people on average signed up every day during the first week of November, according to The New York Times, nearly double the daily pace of enrollments during the first two weeks of open enrollment last year.

Whether that translates to greater enrollment totals in 2018 remains to be seen because of the smaller time window for signing up.

Enrollment figures haven't been released yet in Colorado, with the first numbers from the state's exchange, Connect for Health Colorado, expected Thursday.

"We're running ahead of where we were for a similar period last year," said Luke Clarke, the exchange's spokesman. "But it's too short of a period to make a judgment."

So what can you expect while shopping for health insurance this year? Here's a primer:

How much time left to sign up?

Not as much as in past years.

The first deadline to buy coverage is Dec. 15. That's the date by which anyone who wants coverage effective Jan. 1 must purchase a plan. Miss that date, and you could be stuck without coverage throughout January.

For the dozens of states that rely on the federal exchange, called Healthcare.gov, that date also marks the end of this year's open enrollment period.

But Colorado operates its own exchange, so Colorado's sign-up season runs through Jan. 12.

Who's affected by this open enrollment season?

This sign-up period typically only affects people who do not already have government-based coverage - such as Medicare, Medicaid or Tricare - or who don't have health benefits through an employer.

About 8 percent of the state's population, or nearly 435,000 people, buy plans on the individual market, according to the 2017 Colorado Health Access Survey.

What's new this year?

Once again, rates are on the rise across Colorado.

The monthly price tags - or premiums - of insurance plans will rise an average of 33 percent in 2018. It marks the second straight year of double-digit rate increases, after having risen 20.4 percent for 2017.

The reasons aremany and include the rising cost of care and prescription drugs.

But the uncertainty over Obamacare's future, brought on by Republicans' attempts to repeal and replace the health law, also played a major role. And Trump's decision in October to end certain subsidy payments to insurers led those prices to rise evenmore.

But that isn't all that's new. There's also more federal financial assistance to offset those price increases. As a result, many savvy shoppers can pay less for health insurance in 2018.

What financial help is available?

There are two main types of federal assistance.

Tax credits can cut the cost of monthly premiums. They are largely tied to an enrollee's income - meaning the less someone earns, the greater the tax credit.

These tax credits are available to anyone earning up to 400 percent of the federal poverty level. For a single person, that's slightly more than $48,000 a year. For a family of four, it's slightly more than $98,000.

The other financial help is so-called "cost-sharing" subsidies. They are available to anyone earning up to 250 percent of the federal poverty level - roughly $30,000 for a single person and about $61,500 for a family of four.

They help cut certain out-of-pocket expenses, such as deductibles, copayments and coinsurance. But unlike the tax credits, these subsidies are only available on mid-level, silver-tiered plans.

Didn't President Trump end payments for cost-sharing subsidies?

He did. But that decision only affected federal payments to insurers, not the financial help to shoppers.

By law, insurance companies still must offer the subsidies to customers. Those subsidies remain in place for 2018.

The only difference is that insurers must eat the cost of those subsidies, without hope of federal reimbursement. That's one reason insurance prices rose so much for 2018.

How can I avoid price hikes?

Two words: Shop around.

This year, perhaps more than ever, careful shoppers can find deals on the state's insurance exchange, says Clarke, the exchange spokesman. That's because the value of those monthly tax credits goes up or down in lock-step with the price of insurance premiums. So when insurance rates go up - as they will in 2018 - so do those tax credits.

In some cases, the savings are astounding.

Across the nation, 4.5 million people are eligible for tax credits so great they can get a bronze-level plan for free in 2018, according to the Kaiser Family Foundation.

Is that the case in Colorado?

Yes, in some instances. But again, don't jump at those bronze-tiered deals without shopping around, said Adam Fox, of the Colorado Consumer Health Initiative.

Many of those same shoppers may be able to get a more robust plan - meaning lower deductibles and copays - at relatively low cost by choosing a silver-tiered plan. Such silver-level plans are the only ones featuring those "cost-sharing" subsidies.

"Yeah, they might not have a premium," Fox said, of people opting for free bronze plans. "But they might be able to pay just a little bit towards their health insurance and have a much more robust plan that is not going to make them go bankrupt if they actually need to seek care."

What's the fine print?

A plan's monthly price tag is far from the only factor to consider, Fox said.

Across the nation, insurance companies have been narrowing their networks - including fewer doctors on each plan - to bring down the price of that coverage.

That means shoppers must be careful about which plan they choose, lest they end up unable to see their current doctor, Fox said.

In addition, people who use health care services more often may prefer paying more every month to ensure a lower deductible, the amount enrollees must pay before insurers begin paying claims.

Do I have to shop on Colorado's exchange?

Nope. Insurance carriers can and do sell directly to consumers.

But federal tax credits and subsidies that tamp down the cost of coverage are only available through the state's exchange. So if you want financial help, you must shop on Connect for Health Colorado.

About one-third of people on the individual market, who did not use the state's exchange, may have been eligible for financial help had they simply shopped on Connect for Health Colorado, according to the 2017 Colorado Health Access Survey.

"People need to check to see if they're eligible for the tax credit," Clarke said. "We really recommend it so you don't leave money on the table."

What if I do nothing?

One of two things could happen.

If you're already covered for 2017, and your plan is available for 2018, your coverage likely will automatically renew. But the price of that plan may have changed, along with the tax credits. Hence, the recommendation by consumer advocates to shop around.

"Doing nothing is usually not the best strategy," said Vincent Plymell, a Colorado Division of Insurance spokesman.

Anyone who does nothing while not already covered could face a federal tax penalty for going uninsured in 2018.

Is that tax penalty still in effect?

Despite Trump's suggestions to the contrary, the individual mandate remains in place.

People who go without coverage in 2018 could face a tax penalty of $695 per adult ($347.50 per child younger than 18) or 2.5 percent of a person's yearly household income, whichever is greater. Several exemptions are available, though.

What if my income is less than 138 percent of the federal poverty level?

In that case, you're eligible for Medicaid, also known as Health First Colorado.

Credit: Jakob Rodgers