Open enrollment ‘less chaotic’ this year

Nov. 21--BLOOMINGTON -- People buying health insurance using the online marketplace this fall for 2019 will experience a pleasant surprise: relative stability after several years of rate (premium) increases, fewer health insurance providers and rising deductibles.

"Plans are not that different this year," said Pamela Deaton, a Bloomington-based licensed insurance agent with HealthMarkets. "It's been an easy open enrollment because nearly everyone's plans have stayed pretty much the same."

"It's been a lot less chaotic this year," she said.

But everyone's circumstances are unique so consumers need to do their homework before selecting their health insurance plan for 2019, said health insurance agents, counselors and health care providers.

Open enrollment for people buying health insurance for 2019 using the online marketplace, also known as the exchange, began Nov. 1 and concludes Dec. 15. The websites are getcovered.illinois.gov and healthcare.gov or consumers may call 866-311-1119 or a local, licensed health insurance agent.

It's also the time of year when people who get health insurance through their employer are reviewing their options for next year.

A plan analysis by Illinois Department of Insurance (DOI) for 2019 found that rates have stabilized for the first time in several years.

"Overall, marketplace plans this year are 3 percent cheaper ... which is great for people concerned about the cost of health care," said Orion Tucker, a certified application counselor. Rates, on average, are their lowest since 2015, he said.

Tucker is the outreach, enrollment and financial intake worker at Chestnut Family Health Center in Bloomington. While that facility focuses on services for people on Medicaid, Tucker can assist anyone with questions on open enrollment.

The DOI analysis found that rates for the cheapest bronze plans increased about 6 percent, less than the average 20 percent increase in rates last year.

Help is available

Open enrollment for people buying health insurance for 2019 using the online marketplace continues through Dec. 15. Here's where help is available:

* Go to getcovered.illinois.gov or healthcare.gov, or call 866-311-1119.

* Contact a local, licensed health insurance agent directly or go to healthcare.gov, type in your zip code and find a list of licensed health insurance agents in your area.

* Call the certified application counselor at Chestnut Family Health Center at 309-557-1480.

* Attend an Illinois Department of Insurance Open Enrollment meeting to get questions answered. Upcoming Central Illinois meetings include 4 to 6 p.m. Nov. 28 at Chestnut Health Systems, 1003 Martin Luther King Drive, Bloomington; 4 to 7 p.m. Dec. 3 at Pontiac Public Library, 211 E. Madison St., Pontiac; and 2 to 3 p.m. Dec. 10 at Eureka Public Library, 202 S. Main St., Eureka.

Rates for lowest-cost silver plans decreased 4 percent overall while rates for lowest-cost gold plans decreased about 6 percent from last year, the department reported. Metal categories reflect how consumers share costs.

In addition, a new insurer entered the online marketplace and no insurers left the exchange, meaning there are five insurers on the exchange. But not every insurer operates in every county.

For the first time since the Affordable Care Act (also known as Obamacare) became law, Illinoisans will not face a tax penalty for not having health insurance starting in plan year 2019 for taxes paid in 2020. While the penalty is going away, the insurance mandate is not.

"Some people are talking about Trumpcare but there's no such thing," Deaton said. "It's the Affordable Care Act, it's still in place and the individual mandate is not going away."

While many people in Illinois get health insurance through their employer, 334,979 Illinoisans last year signed up on the marketplace, which was created by the ACA for people who aren't insured through their jobs. Lower-income applicants may qualify for government subsidies to reduce the cost.

But even people with employer-provided plans should analyze them rather than automatically enrolling or re-enrolling, Deaton said.

"Because it's offered (through your employer) doesn't mean it's the best for that person," Deaton said. "I talk to people all the time and they think they have to buy it through their employer and they don't."

"If you are paying more than 9.86 percent of your adjusted gross income in premiums, that is deemed unaffordable and you can look for insurance on the exchange," Deaton said.

Deaton recommends talking with a licensed health insurance agent rather than navigating the website on your own.

But, whether you are working with agent like Deaton, a counselor like Tucker or navigating the website on your own, consumers need to look at more than premiums and deductibles.

"You've got to make sure your medicine is covered, you've got to make sure your pre-existing conditions are covered the way you want them to be covered, you've got to make sure your doctor is in network," Deaton said.

Tucker added that people who see specialists also need to make sure that they're covered.

Mike Romagnoli, executive director of the Community Health Care Clinic, McLean County's free clinic for the uninsured and under-insured, said "Consider what (procedures) you have coming in the next year.

"Do you need to see the optometrist or the dentist first, because most marketplace plans don't cover both," Romagnoli said.

Overall in McLean County, where Health Alliance and Blue Cross Blue Shield are the major insurers, deductible and maximum out-of-pocket costs are increasing but rates are similar and plans haven't changed much, Deaton said.

While the deadline for people to enroll in a plan for next year on the exchange is Dec. 15, people may change their enrollment at any time if they have a life-changing event, such as getting married, a birth or death in the family, losing their job, or experiencing a major change in their income, Tucker said.

Consumers may make changes at healthcare.gov or by contacting an agent like Deaton or a counselor like Tucker.

In addition, people eligible for Medicaid may sign up at any time.

Since he began his job at Chestnut on Sept. 24, Tucker has assisted 30 people in completing Medicaid or marketplace applications.

"My advice to people is to not wait in selecting a plan," Tucker said.

Romagnoli agreed. The clinic, which treats 1,034 patients with chronic diseases, experienced a dip in patients in 2014 when the expanded Medicaid and online marketplace opened and more people got insurance coverage. But they were quickly replaced by patients who lost their jobs and health care coverage and then purchased low-premium, high-deductible insurance that they could afford.

"We do a lot of gap-filling," Romagnoli said.

Contact Paul Swiech at (309) 820-3275. Follow him on Twitter: @pg_swiech

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