Obamacare Enrollment: 4 Things to Know


If you’re interested in getting coverage under the Affordable Care Act for 2016, now’s the time to start shopping. Enrollment opened on November 1 and will continue through January 31 (though, you’ll need to make your final selection by December 15 if you want a policy in place by New Year’s Day). Even if you’re happy with your current ACA policy, it’s a good idea to review your options in the Marketplace, since each new year brings changes to plan costs and benefit designs.

Here are 4 things to watch during this open enrollment period.

1. Rising premiums. This year, premium increases are steeper than last year. Benchmark plans (the second lowest cost silver plan sold in each market and to which tax credits are tied) will jump by an average of 7.5% for 2016. But that’s just the average across 37 states using Healthcare.gov.

Costs will rise much higher in some states. For example, if you live in Oklahoma, you’ll pay an average of nearly 36% more for benchmark plan premiums.

The good news is that most people will be able to offset rising costs by shopping and changing plans. A government analysis found that people who switched plans within the same tier level in 2015 (bronze, silver, gold) spent nearly $ 400 less for the year on premiums after tax credits than they would have if they stayed in their existing plans.

2. Changing costs. The price of a plan’s premium isn’t the only cost that will change. Each year health plans make adjustments to out-of-pocket costs as well. So, check plan deductibles – the amount you must spend before insurance helps cover the bills. You’ll also want to note co-pays and co-insurance associated with going to the doctor or filling prescriptions.

To help you get a sense of what your overall costs are likely to be with different plans, Healthcare.gov is now offering a cost calculator, as well as tools to help you search for plans by participating doctors and covered medications.

3. Provider networks and drug coverage. Generally, plans sold on Healthcare.gov will continue to offer limited provider networks with access to fewer doctors and hospitalsAnd, there are more plans being sold this year that offer no out-of-network coverage at all.

Narrower networks that include fewer doctors are generally cheaper. But there’s a trade-off. Going outside your health plan’s network can lead to high and unexpected costs.

Another detail to check: The list of participating pharmacies and the drugs each plan covers to make sure you’ll have coverage for the medications you take.

Also, make sure you understand the associated costs you’ll face when you go to fill your covered prescriptions. For example, most plans put medications on different tiers that come with varying out-of-pocket costs. And, some plans have a separate deductible for prescription drugs. The way in which these costs are applied can have a huge impact on how much you ultimately spend.

4. Tax credit calculations. Tax credits are available to help lower the cost of insurance for individuals earning between $ 11,770 and $ 47,080 per year. Those earning less than $ 29,000 per year may also qualify to have their out-of-pocket costs reduced.

If you’re already getting a tax credit and don’t renew your plan through Healthcare.gov, your income will be automatically updated by the government with the most current information available.

Still, it’s a good idea to update your information during open enrollment to ensure that you’re not receiving too much or too little help, and to report any changes to your income or household size during the year to keep your information current and to avoid surprises at tax time.