NEW YORK–(BUSINESS WIRE)–HealthCare.com, a leader in technology-enabled health insurance solutions, published today a recent interview with Jeff Smedsrud, a long-time health insurance executive, health reform advocate and co-founder of HealthCare.com, the nation’s largest private comparison site for health insurance. Smedsrud shared six key recommendations for consumers to take into consideration as they shop for health insurance during the next open enrollment period.
1) How has this open enrollment period (OEP) changed?
1. There is no longer a mandate that requires you to buy an Affordable Care Act (ACA) plan or pay a penalty (also known as Obamacare). The penalty for not having an ACA plan is zero dollars. Several states have slightly expanded dates for open enrollment, including, California, Colorado, Massachusetts, Minnesota, New York, Rhode Island and Washington, D.C., so consumers should be sure to check with their state-based exchange.
2. The number of health insurance companies offering ACA plans for 2020 are increasing by one-third.
3. Price increases for ACA plans are much less than they had been in previous years. The overall average will show a 4% decrease on benchmark plans but that percentage will vary based on ZIP codes.
4. There are more established alternatives. New guidance from the Trump administration has strengthened short term medical plans, fixed indemnity plans and expanded the use of health reimbursement accounts (HRAs) for small businesses, making it easier to mix and match types of plans for employees.
2) What options do I have for coverage?
There are really four options.
1. The ACA remains the best choice for millions of people. It offers very comprehensive coverage and cannot deny people based on past medical conditions. An individual or family whose taxable income is below 400% of the federal poverty level should at least consider an ACA plan, and it should be the de-facto plan of choice for those under 250% of the poverty level because premium subsidies will often reduce the cost of these plans to very low monthly costs. For those who earn more than 400% of the federal poverty level and are not eligible for premium subsidies, ACA plans may be the best choice if they have reoccurring health issues or are taking expensive medications.
2. Short term medical plans (also known as term health or STLDI — short term, limited-duration insurance).
3. Fixed Indemnity plans that pay a fixed amount of medical expenses. They are guaranteed for renewal. Think of them as Aflac on steroids. But unlike Aflac plans that are meant to cover copays and a deductible for all kinds of insurance, these fixed indemnity plans are meant to be your primary health insurance. But be careful. Many of these plans provide cash payments for medical expenses, but only pay a fraction of the cost. They are an okay choice for some individuals but buyer beware — you need to be a real shopper of healthcare services since you will need to navigate all the differences in actual medical costs by yourself.
4. Faith-based plans, also known as Christian sharing ministries, are very popular. The requirements to be a Christian have loosened in recent years, but many plans are medically underwritten — meaning those with health problems might be denied coverage — and most have so-called “moral clauses” which will deny payment for such things as pregnancy out of wedlock, an accident caused by alcohol or drugs, or illness caused by tobacco use. Additionally, these faith-based plans are not subject to ANY state or federal insurance regulations for solvency, or required benefits. But many people like them because they cost less than an ACA “permanent” plans that can be renewed every year, subject to rate increases.
3) Are short term health insurance plans a good choice for everyone in good health?
These plans are a good choice for those in need coverage for a certain period of time or believe that an ACA plan is not affordable. However, they are not generally available for those with pre-existing medical conditions that require immediate treatment.
The number of people enrolled in STM plans has grown, and many states allow them to be renewed for up to 36 months. But a 36-month plan usually costs more each month than a plan that ends after, for example, six months. So — if you only need coverage until a new job in three months, or until the next open enrollment period in less than a year, why buy the more expensive longer-term plan?
4) If I don’t buy an ACA plan, is there a minimum amount of time I should keep an alternative plan?
Only ACA plans are guaranteed issue without regard to health status. Thus, if you buy a short term medical plan, a fixed indemnity or faith-based plan make sure you can keep the plan at least until the next open enrollment period. You don’t want to have coverage that ends before next year’s open enrollment because you could be stuck without coverage unless you qualify for special enrollment situations — like moving out of state, a divorce, birth of a child and other reasons.
5) Is healthcare.gov the only place I can visit to get premium subsidies for Obamacare plans?
Not really. This year the government has approved what is called electronic direct enrollment (EDE). Private web sites like Kind Health, Health Sherpa, Stride, Get Insured and HealthCare.com have either been approved by the government or made arrangements with approved private sites, that allow most of the enrollment process to take place outside of healthcare.gov. But there remains an electronic “handshake” between healthcare.gov and those private companies.
6) What is your top recommendation for consumers?
Trust your own instincts about what you can afford, be honest with yourself about your medical conditions and likely prescription drug purchases, work with a trusted advisor — either in person or online. And most importantly — don’t go without any health insurance. Finally, remember: Politicians have the responsibility to do what is right for our country’s long-term future about healthcare. Your responsibility is to do what is right for you.
HealthCare.com is an online health insurance company providing a data-driven shopping platform that helps American consumers enroll in individual health insurance and Medicare plans. HealthCare.com also develops and markets a portfolio of proprietary, direct-to-consumer health insurance and supplemental insurance products under the name Pivot Health. Founded in 2014, the company is headquartered in New York City, and is backed by PeopleFund and individual investors including current and former executives of Booking.com and Priceline. HealthCare.com is a 4-time honoree of the Inc. 5000 list of America’s fastest-growing companies. For more info, visit http://www.healthcare.com/.