Blog Post  Cut Through the Clutter: NAIC’s Tips For Health Insurance Open Enrollment

As open enrollment period begins, many Massachusetts residents must soon make 2018 health insurance choices amid a barrage of news and opinions regarding healthcare. To help make the most informed decisions possible, the National Association Of Insurance Commissioners (NAIC) encourages consumers to streamline their health insurance research process. First, determine which coverage option best fits their financial and health situation. Then, focus solely on information and updates specific to that category.

According to the U.S. Census and Kaiser Family Foundation, most Americans access healthcare in one of three ways:

• Employer-Sponsored: 49 percent of Americans participate in a group health insurance plan offered by their employer. This includes employees of large and small private companies, federal, state and local government employees and active military. Companies with 50 employees or fewer may opt to provide coverage through the SHOP (Small Business Health Options Program) Marketplace.
• Public Programs: 35 percent of Americans receive healthcare benefits through Medicare, Medicaid or other public programs.
• Individually-Purchased: 7 percent of the population purchase health insurance on their own.

Under each category, there are important developments and information consumers should keep in mind as open enrollment begins:

Employer-Sponsored Health Insurance

• If you’re already covered by an employer-sponsored plan, pay close attention to your enrollment options this year. Premiums and coverage limits may have changed.
• If you’re changing jobs, you may be subject to a probationary period, up to 90 days, during which you are not eligible for group coverage.
• If you lost coverage from a previous employer, you typically have 60 days to enroll in private individual insurance on an exchange through a Special Enrollment Period.

Public Healthcare Programs

• Medicare and Medicaid are government programs that help pay for health care. However, benefits, costs and eligibility requirements differ:
  • Medicare is a federally funded program available to most U.S. citizens and permanent legal residents age 65 or older who have lived continuously in the country for at least five years. People younger than 65 also may be eligible for Medicare if they are disabled, suffer from kidney failure or ALS (Lou Gehrig’s disease). The program is administered in four parts, not including Medigap private insurance plans.
  • By contrast, Medicaid is jointly funded by federal and state governments. Eligibility is means-based, and the program has strict income requirements that vary from state to state.
• Medicare open enrollment for Medicare Advantage and Medicare Prescription Drug coverage (Part D) takes place from Oct. 15 through Dec. 7, 2017. If you miss the deadline and didn’t experience a qualifying event, you can apply during general enrollment (Jan. 1 through March 31 of each year), though you will have to pay a premium penalty.
• High-income earners (above $133,500) may see increases² in 2018 Medicare Part B premiums. Enrollees should contact Medicare for an estimate and plan accordingly.
• Medicaid enrollees should pay particular attention to possible changes to eligibility and coverage options in their state.

Individually-Purchased Health Insurance

• The 2018 healthcare.gov open enrollment period is now Nov. 1 through Dec. 15, 2017. (Open enrollment dates for state exchanges vary.) Coverage begins Jan. 1, 2018. Consumers can begin researching options any time.
• If you currently have coverage through the exchange and do not choose a plan for 2018, you will be re-enrolled in the same or a similar plan.
• Consumers can now enroll in the healthcare exchange marketplaces through third-party insurers’ websites. The new direct enrollment option allows agents to handle the entire transaction. Compare plans before buying to understand all choices.

To avoid getting lost in the plethora of information about health insurance, the NAIC offers the following recommendations to help consumers rethink their research process:

1. Start early. The more information you gather, the smarter your decisions.
2. Stay abreast. The health insurance landscape is evolving rapidly. What is true today may be false tomorrow.
3. Shop around. What made sense this year may not be the best solution next year, particularly if your employment situation has changed. Take time to shop around.

For additional help, download the Annual Health Insurance Check-Uprom Insure U. The new resource offers guidance and tips to help consumers tune out the “noise” and focus on information specific to their financial and health situation. Massachusetts consumers interested in health insurance information can contact the MA Division of Insurance.