What’s new and what to watch for in the upcoming ACA enrollment period?

It’s that time of year again: The annual open enrollment season for health insurance under the Affordable Care Act is beginning in most states November 1st and lasts until January 15th.

Current participants who do not update their information or select an alternative will automatically be reinstated to their current plan or, if that plan is no longer available, to a plan with similar coverage.

Last year saw a record number of around 21 million people. This time, consumers will notice that some things have changed.

Don’t fall for advertising scams

While some health insurance companies offer small gift cards or other incentives to encourage participation in wellness activities, they would not offer cash cards worth thousands of dollars per month to help with groceries, gas or rent. Yet social media and online sites are awash with such promises.

Such advertisements are among the opportunities allegedly used by unscrupulous brokers who purchase or switch plans without consumers’ explicit consent. according to a lawsuit filed in Florida.

Also, be careful about the websites you use to search for insurance coverage.

Type “Obamacare” or “cheap health insurance” into a search engine, and private sector sponsored websites that are not affiliated with the official state or federal government marketplaces for ACA insurance often appear first.

Even though they try to look official, they are not. Many of these sites offer a variety of options, including non-ACA coverage with limited benefits. A 2023 Secret Shopper study found that such non-ACA coverage would not be eligible for federal subsidies to help consumers pay premiums.

The fine print on some websites states that consumers who provide personal information automatically consent to be contacted by sales representatives via telephone calls, emails, text messages or automated systems with pre-recorded messages.

When exploring plans, always start with the official federal marketplace website. Healthcare.gov.

Even if you don’t live in one of these areas 29 states are served by the federal marketplace. On the website, you will find a link to your official registration page when you select your state or the District of Columbia from a drop-down list. Federal and state marketplaces also have call centers and other opportunities to receive enrollment assistance. For example, the Find Help Local link on Healthcare.gov allows consumers to find helpers or sales representatives in their area.

Is it real insurance?

Another cause for concern: Regulators are seeing an increase in consumer complaints about health insurance offerings that require consumers to join a limited liability company or otherwise certify that they work for a particular company. In fact, at least two states – Maryland And Maine — have warned that instead of comprehensive ACA coverage, it often involves non-ACA products that amount to, for example, a hodgepodge of discount cards or limited compensation plans. This type of plan pays a flat amount—for example, $50 for a doctor’s visit or $1,000 for a hospital stay—and is intended to support, not replace, more comprehensive coverage.

“Unlike large health insurance plans, some of these self-funded plans only cover preventative services such as an annual exam or annual health screening,” the Maine Bureau of Insurance alert said.

Premiums could be higher… and other new things

Some insurers will reduce premium rates for 2025, but many others will increase them.

Although the final numbers are still being determined, experts estimate an average increase in premiums of 7%. According to an analysis by KFF, a nonprofit health information organization that includes KFF Health News. Most people who get ACA insurance will be eligible for a subsidy to cover premiums, which likely offsets much of the increase, although the higher cost means the government will pay more for these subsidies.

Rising healthcare costs – including for hospital care and the new class of weight-loss drugs – are contributing to this increase.

Some other changes in this open season:

• People often called “Dreamers” because they qualify for the Deferred Action for Childhood Arrivals — a federal program that provides some protections to people brought to the country as children without proper immigration documents — can Enroll in ACA insurance now and be eligible for subsidies.

• Short-term plans that are not technically ACA coverage and are not subject to the benefit rules and pre-existing benefit protection rules may be issued coverage for a maximum of four months under a Biden administration action that went into effect with plans starting September 1. It rolls back a Trump administration rule that relaxed requirements to allow insurers to offer up to 364 days of coverage and gave insurers the option to extend policies for up to two additional years. This is not the case for existing plans and those issued before September 1st fall under the new rules. But consumers who have relied on the longer periods need to review the details of their plans and consider enrolling in an ACA plan instead to avoid having their short-term plan expire at the beginning or mid-year and potentially leaving them for will not be able to obtain any other insurance coverage for the remainder of the year.

The registration process may also take longer

Federal regulators have struggled with a growing number of complaints this year – 200,000 in the first six months alone – Consumers who were enrolled in or switched from ACA plans without their express permission by agents seeking commissions.

To thwart such efforts, they have introduced new rules.

What does this mean for most consumers? If you’re working with a new broker – one who isn’t already listed on your ACA plan – you’ll likely need to have a three-way conversation with the federal marketplace to confirm that you’re actually giving that broker permission to make changes to your policy for the coming year Year. Please allow for this to take additional time. No one knows how busy call lines will be during open enrollment.

You don’t have to use a broker to register. However, because it’s challenging to wade through the dozens of options on the market, most people actually seek help. Consumers must weigh not only the monthly premium cost, but also differences in deductibles and copays for things like doctor visits, hospital stays and medications.

Shop around

Experts say that when choosing a plan, you should also consider whether the network includes the doctors and hospitals you normally see and whether the formulary covers your prescription medications and how much they charge for them.

To make comparisons easier, rules took effect two years ago that require insurers to offer some “standardized plans” as options, all of which must have the same deductibles and costs for things like doctor’s visits, emergency room visits and other consumer cost-sharing.

Still, many people have dozens of options available to them, which can be daunting.

However, one piece of advice remains: whether you’re signing up for the first time or already have a plan, it’s always worth shopping around. Even if you don’t change your plan, you can make sure the plan you have is still your best option.

In most states, consumers must enroll by December 15th to receive coverage that begins January 1st. Note in Idaho, where open enrollment begins earlier – October 15th – but also ends earlier, ending December 15th. In California, New Jersey, New York, Rhode Island and the District of Columbia residents have until January 31 to register.

This story was published on October 8, 2024 by KFF Health News. It is republished with permission.

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