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11 things you should know about marketplace open enrollment 2020 in Pennsylvania

October 31, 2019 | By: Jolene Calla Vice President, Health Care Finance and Insurance The Hospital and Healthsystem Association of Pennsylvania

11 things you should know about marketplace open enrollment 2020 in Pennsylvania

The Affordable Care Act’s Health Insurance Marketplace turns five this year. The open enrollment process is similar to last year’s:

  • You have six weeks—from November 1 to December 15, 2019—to go to healthcare.gov and select a health plan for next year
  • Pennsylvanians’ choice of health plans continues to grow, with more plans available this year than last
  • Premiums in Pennsylvania’s individual market, on average, are about 4 percent more this year than last, but nowhere near the double-digit increases of several years ago—and premiums for some plans have gone down

Do you want to keep the same plan you have now? Are you shopping for a new plan? Is this your first time buying your own insurance? These questions and answers will help you get started.

  1. Why is it called Marketplace Open Enrollment 2020 if happens in 2019?

Open enrollment is the period of time toward the end of the calendar year when you can enroll in a health insurance plan, or choose a different plan for the coming year. If you sign up for a plan during this time, your coverage begins on January 1 of the next calendar year.

That’s why this year’s open enrollment is called Open Enrollment 2020. It’s your chance to sign up for the health plan you will have during calendar year 2020.

If you get your insurance through healthcare.gov now:

  1. Should I expect premium increases?

That depends on the plan you choose. Premiums for many plans went up, but some premiums went down. That’s all the more reason to take the time to shop carefully, making use of the help that’s available.

Most people and families who get their coverage through healthcare.gov qualify for financial help, called advance premium tax credits. These greatly reduce monthly premiums. If your income and other factors are about the same this year as last, this financial help will make your monthly premium payments affordable even with a bit of an increase in your plan’s premiums.

Taking into account all the different premium increases and decreases, the premiums for Pennsylvania’s individual market as a whole saw, on average, a 4 percent increase.

  1. I want to keep the same plan that I have now. Do I have to do anything?

If the same plan is offered for 2020, and you are still eligible, you will be automatically enrolled in it. So yes, technically, you will have coverage even if you do nothing.

Still, you should review the 2020 version of your plan carefully and update your financial information even if you want to keep everything “the same.” Here’s why:

  • The doctors, hospitals, and medications covered by your plan may have changed. Check the plan details to make sure they still meet your needs.
  • Your health—or that of your family—may have changed. Make sure the plan will meet any new health needs you might anticipate for 2020.
  • Your income may have changed. You should update your income and household information every year. If you skip this step, you could miss out on additional financial help or end up owing money.After you update your financial information, you also must select a plan—even if you just want to select the same plan you have now. That’s just how healthcare.gov works.
  • You could end up with a different health plan! If your insurer leaves the marketplace or discontinues the plan you have now, you will be automatically enrolled in a similar plan. Unless you have certain life events (such as getting married, having a child, or moving), you will likely have to stick with that plan for an entire year, whether you like it or not. 

Be sure to review the renewal notices sent by the marketplace and your current insurance company. These will alert you to:

  • Any changes in your plan’s premiums, coverage, and benefits for 2020
  • The new plan you were automatically given, if your current plan is no longer offered

You should have received these notices before the start of open enrollment on November 1, 2019.

  1. Why is it important to update my financial information?

Updating your financial information has advantages for households with lower incomes, as well as those with growing incomes.

If you expect your household income to go down during 2020, you should update your financial information. That way, you will get all the financial help that’s available for your income level.

You also should update your financial information if you expect your household income to go up during 2020. You may receive less financial help as a result. But this “pay as you go” approach is probably a better way to manage your finances than finding out at tax time that you owe a large lump sum because you received more financial help than you should have.

  1. I received a notice saying the plan I have now is discontinued. Now what?

Insurers can drop plans or leave the marketplace from one year to the next. If this happens to your plan, the marketplace automatically enrolls you in a similar plan. That way, even if you miss open enrollment, you will still be covered.

To make sure you get the best plan for your health and finances, you should go to healthcare.gov and do your homework. Review your options for next year, and select the plan that best meets your needs. Be sure to act before the deadline on December 15, 2019.

If this is your first time getting insurance through healthcare.gov:

  1. How do I get started?

Are you buying health insurance for the first time? Even for someone like me, who works in health care, health insurance can seem complicated and confusing.

The Pennsylvania Insurance Department’s website has very short videos that explain the basics. Start with this video about how to shop for insurance. The videos have fun graphics, are easy to understand, and are only a few minutes long!

Use the healthcare.gov website—officially called the Health Insurance Marketplace—to choose your health plan and enroll. Healthcare.gov has quick and easy ways to help you get started with the process, including:

You also can:

  • Connect with someone called a navigator (also called an assister), who is trained to help walk you through the process step by step
  • Use online resources like the Pennsylvania Insurance Department’s Consumer’s Checkbook Plan Comparison Tool

If you are considering a less expensive “off marketplace” plan:

  1. Can I buy a plan off the marketplace that’s a little bit less expensive, but just as “good,” as the one offered on the marketplace?

Yes. But:

  • You have to be very careful about what you are buying—review all the details!
  • These plans are of most benefit to households with incomes too high to qualify for the financial help offered only on the marketplace.

Many insurers that offer policies through the marketplace also offer identical policies outside of the marketplace, in the individual health insurance market. These plans meet marketplace standards, including covering pre-existing conditions without charging more or limiting benefits.

Insurers can offer these plans outside the marketplace for a little less in part because administrative requirements are a bit simpler. However, many “off marketplace” plans provide coverage that falls far short of marketplace standards. Buyer beware!

  1. What are some of the limitations of “off marketplance” plans? What kinds of plans should I be most cautious about?

Different kinds of short-term plans, available off the marketplace during open enrollment, are designed to provide stopgap or “bridge” coverage if, for example, you are between jobs.

These plans are now aggressively being promoted as less expensive alternatives to the marketplace. But they provide very limited coverage—no maternity care, for example—and have tight dollar caps that can leave you financially vulnerable. Many provide no coverage for pre-existing conditions.

Examples of short-term plans include association health plans, short-term limited duration plans, and health care ministries. You are likely to run into these, and their attractively low monthly premiums, if you google for health insurance options during open enrollment.

Carefully read the fine print before you decide to go this route. The price may well be too good to be true—and too low to provide reasonable health coverage in the event of a serious accident or illness.

  1. What about the catastrophic plans offered on the marketplace?

Catastrophic plans are available only to:

  • Adults up to age 30
  • Older people who can’t find any other marketplace plan that costs less than 8.24 percent of their income

The name says it all. Catastrophic plans are limited, intended to cover only big health care bills resulting from major health care crises. For spending on covered health care services up to $8,150 a year ($16,300 in family plans), you’re on your own.

Catastrophic plans, like others on the marketplace, do cover preventive care at no cost to you. After you’ve spent the required amount ($8,150 or $16,300 for families), the plan will pay 100 percent of covered in-network services for the rest of the year.

If you need help choosing a plan and enrolling:

  1. How can I find someone to help walk me through the process?
  • Call the healthcare.gov help line at (800) 318-2596. The Pennsylvania Insurance Department also can help. Call Customer Services at (877) 881-6388. 
  • Look up a nearby “assister” at healthcare.gov. Assisters (also called navigators) are trained to walk you through your different health insurance options and find the best plan for your household, health, and financial circumstances.
  • Assisters typically work at not-for-profit organizations. Unlike agents or brokers, assisters receive no commissions or other financial benefits based on the type of plan you choose.
  • To find an assister organization, click Find Local Help on healthcare.gov. To look up only assisters, close the agent or broker button by clicking the “X.”
  • Ask for help at hospitals, clinics, libraries—and your friends and neighbors.
  • Call or visit your local hospital or health care clinic. They have financial counselors who can help match you with insurance options or direct you to other sources of assistance.
  • If you need access to a computer, your local library can help. Many libraries also can direct people to help with open enrollment.
  • Do you have family, friends or neighbors who work in health care? They will help you—or direct you to someone who can. I helped my daughter, my nephew, and my cousin enroll.
  1. Are there online resources I can use?

The Pennsylvania Insurance Department has a great online resource, called the  Consumer’s Checkbook Plan Comparison Tool, for reviewing and comparing health plans that meet your needs based on:

  • Where you live
  • The people who live in your household
  • Your income
  • Your household’s prescription drug needs

Do you still have questions? Kasier Family Foundation has a searchable list of hundreds of questions and answers that cover a host of specific situations. This list includes more than 20 questions about renewing marketplace coverage for 2020. Other sections cover marketplace eligibility, plans and premiums, and short-term policies.

Of course, you could always post a question for me in the comment section below. I work for The Hospital and Healthsystem Association of Pennsylvania, and we want as many Pennsylvanians as possible to have health coverage.

Written by HAP Admin



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