First published in Landings, June, 2017

On April 18, the Department of Health and Human Services (HHS) issued a final rule to address certain issues with the health insurance marketplace and to provide flexibility to issuers to help draw healthy consumers to enroll in health coverage, improve the risk pool and bring stability to the individual markets, while increasing options for patients and providers.

This final rule also makes significant changes to the enrollment period for the 2018 benefit year. HHS shortened the enrollment period to November 1 to December 15, 2017, cutting the open-enrollment period from 12 weeks to 6. Having an open-enrollment period that begins and ends in the same calendar year is potentially beneficial because it means the effective date for all policies will be January 1, 2018, which allows everyone enrolling to receive full-year coverage. In addition, this window aligns with the traditional open-enrollment periods for Medicare and many employer-sponsored insurance plans and therefore allows for easier plan comparisons for individuals.  HHS believes that a shorter enrollment period will improve the individual health insurance markets’ risk pools by prohibiting individual enrollment in late December and January.

Another change is designed to ensure more choices for consumers for 2018 and beyond. Th e Affordable Health Care Act requires health insurance companies to off er plans that fit into one of three levels — bronze, silver, or gold — that are designated based on their “actuarial value” (AV). Actuarial value refers to the percentage of the average total healthcare costs that a plan will cover. For example, if a plan’s AV is 60%, the plan will cover 60% of total costs, while consumers are on the hook for 40%. Therefore, lower AV plans often have higher out-of-pocket costs, such as copay and deductibles, because the plan isn’t covering as much of the average total costs. The final rule will allow insurance companies additional actuarial value flexibility to develop more choices with lower premium options for consumers. 

With the shorter open-enrollment period this year, it doesn’t hurt to start thinking about your health insurance options. What might be your healthcare needs for next year? Th e best indicator of what you should consider for yourself and your family is how you used your plan during this year. Create a checklist of questions for you and your family to help you consider what changes you should make, if any. Here are a few questions worth adding to your list:

•How much did you use your plan last year?

• Did you hit your deductible?

• Did you use all your no-cost benefits?

•Did the family members covered by your plan do the same?

• Do you anticipate that you or your family members will need major medical procedures in the coming year or are considering pregnancy?

You should use the answers to these questions to help you determine whether you need to change plan options for the coming year. For example, if you anticipate a major health need for yourself or a family member covered by your plan, you may want to consider a lower deductible and lower maximum out-of-pocket plan if that works financially for your family. Pulling together this information now will help you make the best decision when it is time to select a new plan or renew your existing plan.

Did you know?

More than 75,000 people in Maine currently have health insurance coverage through the Affordable Care Act.