Obamacare 2015: Health Care Options for Consumers
Policy + Politics

Obamacare 2015: Health Care Options for Consumers

Obamacare’s health state and federal health exchanges will open for business on Saturday—as the law’s second open enrollment period officially begins. 

Health officials and advocates are hoping to avoid a repeat of last year’s nightmarish rollout, which was plagued with technical glitches and cancelled policies. 

Related: Obamacare Year 2: High Hopes, Huge Challenges 

Health and Human Services Secretary Sylvia Burwell has continuously assured reporters that the website will work and provide consumers with a good shopping experience, although she has also cautioned not to expect perfection. 

Last year, some 8.1 million people signed up for coverage through the exchanges, but that number was reduced to 7.1 million because of ineligibility and non-payment. This year, HHS is expecting about 9 million people to sign up—a cautious estimate that is well below the Congressional Budget Office’s earlier projection of 13 million. 

The administration and some health advocates are leading an aggressive outreach effort to get uninsured people enrolled this year. Enroll America, an advocacy group, said it has raised more than $20 million ahead of the open enrollment period that will be put toward outreach efforts across the country. 

Related: Obamacare 2015: Low Premiums Increases, High Deductibles

Here’s what consumers need to know about enrolling for one the president’s health care plans in 2015. 

Obamacare’s open enrollment period lasts 90 days beginning Saturday, November 15 until February 15, 2015. Last year’s open enrollment period was extended because of the various website issues. However, consumers should not plan on an extension this year.

Of course, there are some exceptions that allow people to sign up after the enrollment period ends. If consumers experience a life change—or “qualifying event” like a new job, the birth of a child, or getting married/divorcedthey can sign up outside of the enrollment period. If consumers want coverage starting immediately on January 1, they must enroll by December 15.

The Exchanges 
Consumers can either visit the federal exchange website—HealthCare.gov, or, if they live in a state with its own marketplace they will be redirected to that website. Once there, consumers can shop for coverage, look at the different plans offered and determine whether you qualify for financial assistance. Last Sunday, HealthCare.gov launched a tool that allows people to “window shop” or scope out all of the options for policies sold in their area. However, consumers won’t actually be able to pick a plan until Saturday.

If you signed up for a plan on the health exchanges last year, you have from now until December 15 to alter your policy. If your income has changed or you want to add or remove a family member, it’s best to update this information immediately as it could affect what kind of financial assistance, if any you receive. Consumers who don’t update their existing plans will be automatically renewed after the deadline. Health officials and advocates have repeatedly encouraged Obamacare enrollees from last year to shop around instead of simply auto-renewing, as policies have changed and they may end up paying more than necessary.

Is the Website Working?
The Obama administration claims that HealthCare.gov has been repaired and revamped and is ready for round 2. Officials in states that had similar technical troubles have also said their websites are functioning properly and will provide consumers with a good experience.

However, if consumers encounter a problem with the website or wish to use an alternative, they can sign up via the call centers, or in-person through navigators. Some states that had website problems last year, have hired massive teams of navigators this year to help people enroll in person.

The Plans and the Costs
There are four types of plans available. Add about 6-8 percent to last year’s average premiums to estimate what you’ll pay each month this year. The maximum out-of-pocket cost limit for any individual Marketplace plan for 2015 can be no more than $6,600 for an individual plan and $13,200 for a family plan, according to HealthCare.gov.

  • Bronze Plans are designed so that insurance companies will typically pay 60 percent of covered healthcare expenses with the remaining 40 percent to be paid by consumers. The consumer’s expenses will be in the form of out-of-pocket fees over and above the cost of the plan’s monthly premium.
  • The Silver plan—the standard plan--pays 70 percent of costs; the gold plan pays 80 percent; and the most robust plan.
  • The Platinum plan, pays 90 percent of costs and has the highest premiums. In all cases, the lower the premium, the higher the deductible.
  • There’s also the catastrophic plan offered only to those 30 and under or those with the hardship exemption. These plans contain very barebones coverage and have very narrow provider networks. 

Despite fears that Obamacare premiums would skyrocket this year, several independent analyses of rates set by insurers in a handful of states have suggested that the price of premiums will only increase slightly—by an average of about 6-8 percent. The price of premiums has increased each year long before the Affordable Care Act, so that’s not surprising. However, health experts say that a number of provisions in the ACA have actually helped slow down the growth rate. 

The actual price of monthly premiums varies greatly depending on where you live. Urban areas tended to see smaller price increases from last year, compared to more rural areas where there might not be as many insurers competing in the marketplace. 

However, while plans sold on the health exchanges tend to have lower premiums, they also have higher deductibles than policies sold off the exchanges.An earlier study by HealthPocket Inc found that the average individual deductible for Obamacare’s bronze plan was $5,081 a year. That's 42 percent higher than the average deductible of $3,589 for a comparable individually purchased plan.  

Doctors and Networks  
Many plans purchased under Obamacare contain narrow networks in order to keep the cost of premiums relatively low. This means plans have limits on the doctors and hospitals available. Last year, a study by McKinsey and Co found that approximately 70 percent of the exchange plans are either narrow or ultra-narrow plans. 

Some hospitals have also opted out of accepting Obamacare policies. Since the exchange plans offer more inexpensive plans, insurers provide less money to hospitals for their services. So some hospitals have decided it isn’t financially feasible for them to take these policies. 

Of course, insurers had been narrowing network plans before Obamacare. As Sarah Kliff noted in The Washington Post last year, narrowed networks grew from 15 percent of employer-based plans in 2007 to 23 percent in 2012. 

The Subsidies 
Consumers earning up to 400 percent of the federal poverty level, or about $46,000 for an individual or $94,000 for a family of four, could qualify for financial assistance. The amount of the subsidy depends on income and the type of plan consumers select. People eligible for subsidies must be United States citizens and are not eligible for coverage through an employer-based plan or through Medicare or Medicaid.

Consumers can find out if they qualify on either the state or federal exchange websites. If you qualify for a subsidy during the application and enrollment process, you will be asked whether you want your subsidy applied toward your health insurance premiums on a month-to-month basis or you can claim it on your 2014 federal tax return.

The Kaiser Family Foundation also has a helpful subsidy calculator here. 

The Penalties 
Under the ACA’s individual mandate, the penalty in 2015 for not having health insurance is $325 per adult and $47.5 per child. Or 2 percent of your total household income, whichever is greater. If you don’t have health insurance (whether its from an employer or through a private plan) the fee will be applied to your annual taxable income for each month you don't have health insurance beginning after March 31. 

Of course, there are exemptions to the penalty. People who are uninsured for less than three months, people who pay more than 8 percent of their household income for health coverage as well as people with incomes below the threshold required for filing taxes--$9,750 for an individual and $27,100 for a family of four in 2012. There is also the ACA’s so-called “hardship exemption” that exempts people from the penalty. This is made on a case-by-case basis and ruled through the marketplace. Read all the exemptions here. 

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