Starting Nov. 1, Only 45 Days To Purchase Health Insurance For 2019

Consumers will have the shortest open enrollment period yet to shop for 2019 health insurance plans – 45 days — but they can “window shop” and compare plans beginning today.

Open enrollment for health plans effective Jan. 1, 2019, will run from Nov. 1 to Dec. 15, giving consumers the least amount of time to enroll in or renew plans since the Affordable Care Act (ACA) became law. Last year, consumers had an additional week.

As a result, Access Health CT (AHCT), Connecticut’s health insurance exchange, is broadening its outreach and marketing efforts and, for the first time, giving consumers a sneak peek at plans.

“A lot of people want to see what options they have ahead of open enrollment,” said AHCT Marketing Director Andrea Ravitz. “Every year, we need to remind individuals that they have choices. We want to make sure they have access to as much information as possible to pick the right plan.”

Consumers can browse plans starting today (Monday, Oct. 22) using a special tool at accesshealthct.com. In addition, AHCT is holding a series of events across the state and offering phone, online and in-person assistance to help individuals choose a plan.

The average ACA monthly premium cost was $689 this year, but for 75 percent of enrollees the average subsidy was $600, according to a report from the Centers for Medicare & Medicaid Services.

The marketplace has two insurance carriers, ConnectiCare and Anthem. Many plans offered for 2019 under both carriers will cost more, but in September state regulators drastically reduced the rate hikes both carriers had sought.

This year’s marketplace offers plans from ConnectiCare and Anthem. Open enrollment is Nov. 1-Dec. 15.

Anthem had proposed a 9.1 percent rate increase for 2019 plans, but regulators approved an average premium increase of 2.7 percent. ConnectiCare had sought a 13 percent increase, which was pared down to an average increase of 4 percent.

As in the past, plans are organized into bronze, silver, gold and platinum categories, and consumers should compare plans to see what works best for them. Platinum plans, for instance, typically have higher premiums but lower out-of-pocket costs, whereas bronze plans have the lowest premiums but highest out-of-pocket costs.

No ‘Opt Out’ Fines

One big change consumers will notice for 2019: There will be no financial penalty for opting not to buy insurance.

In previous years, most consumers had to have insurance or face a fine. Those who had no insurance in 2018 will pay either 2.5 percent of their yearly household income or $695 per person ($347.50 per child), whichever is higher, when they file their 2018 tax returns in early 2019.

Ravitz said AHCT conducted focused groups with about 60 individuals to gauge whether the absence of a penalty would impact enrollment trends for 2019.

“The majority said, with or without the tax penalty, it wouldn’t affect their decision,” she said.

The Marketplace

AHCT is the online marketplace created by the ACA, sweeping health care reform legislation that requires most Americans to have health insurance.

During open enrollment, people without coverage can shop for insurance plans and those with coverage can renew or change their plans.

Ravitz said it is too soon to predict how many people will enroll in plans through the exchange this year, but 114,134 did last year, up more than 2 percent from the previous year. Of those, most—about 73 percent—enrolled in plans offered by ConnectiCare.

Various improvements have been made to AHCT’s website, including enhanced live chat capabilities and a new “Compare Plans” link that will let consumers see various plans’ physician networks, prescription coverage, out-of-pocket expenses and other benefits, Ravitz said.

“This is going to allow people to make better, more informed choices,” she said of the comparison tool. While monthly premium costs often play major roles in which plans consumers choose, she added, “We want to make sure people are able to make better decisions rather than just looking at the price tag.”

After open enrollment ends on Dec. 15, consumers can sign up for 2019 coverage only if they have a qualifying life event, such as loss of insurance, marriage or the birth of a child. New this year, pregnancy is now a qualifying life event.

Consumers can apply online, call AHCT at 855-805-4325, get in-person help, or use AHCT’s free mobile app for smartphones or tablets.

While most people have to wait until Nov.1 to enroll in plans, enrollment in Medicaid HUSKY and the Children’s Health Insurance Plan (CHIP) is open year-round to eligible people and families.

AHCT, now in its sixth year, also will open seven enrollment centers statewide in early November where people can receive in-person help, and will host six enrollment fairs. In addition, it will host a traveling series of educational discussions called “Healthy Chats,” during which experts will speak to groups of people about enrollment options as well as answer questions.

Usually, some people—about 15 percent of those who enroll in plans through AHCT—have trouble verifying the income or citizenship information they must submit once the open enrollment period ends, Ravitz said. AHCT is increasing efforts to reach and help those people too, she added.

Bans Discrimination For Pre-Existing Conditions: Insurers must cover people with pre-existing conditions and they cannot arbitrarily cancel a policy because an enrollee gets sick.

Free Preventive Care: The law continues to broaden access to free preventive care. New rules regarding testing and medications to reduce the risk of breast cancer went into effect in 2015. Plans must cover (without cost-sharing) risk-reducing medications, such as tamoxifen and raloxifene, prescribed to women with increased risk of breast cancer.

Expanded Coverage For Young Adults: Young adults up to age 26 who do not have access to job-based health insurance can stay on a parent’s plan whether or not they live at home or attend school. The law applies to all health plans, even those that are self-insured.

Annual And Lifetime Dollar Limits: The law ends lifetime and yearly dollar limits on coverage of essential health benefits. That means Connecticut residents with insurance no longer need to worry about going into debt when their coverage runs out.

Essential Benefits: Insurers must provide a minimum level of coverage under 10 categories known as “essential benefits,” including preventive care, emergency services, hospitalizations, outpatient care, maternity services, laboratory services, mental health and substance abuse treatment, pediatric care (including vision and dental), prescription drugs, and rehabilitation and habilitation services. The law applies to all plans sold in the private market or through AHCT—except plans from self-insured employers and grandfathered policies sold before March 23, 2010.

Standardized Benefit Explanations: Health insurers must provide policyholders with standard disclosure forms (no more than four pages) summarizing benefits and coverage, including information about deductibles, copayments, out-of-pocket limits and excluded services. The standard format allows consumers to make informed decisions based on apples-to-apples comparisons of health plans.

Consumer Rebates: Consumers whose private insurance carriers do not spend at least 80 percent of premium dollars on health care and quality improvements can expect to receive a rebate each year.

Prescription Drug Savings For Older Adults: Medicare recipients who reach the prescription coverage gap, known as the “donut hole,” will get a 55 percent discount on brand-name prescription drugs and a 35 percent discount on generic drugs. The donut hole, the point at which people must start paying for their medications, disappears by 2020.

Scrutinizing Premium Increases: Insurance companies seeking premium increase rates of 10 percent or more for plans in the individual market trigger an automatic review by the Connecticut Department of Insurance.

For addresses of Access Health CT’s enrollment centers click here.

Sources: Healthcare.gov, Access Health CT

This report was compiled by Cara Rosner.