It’s That Time of Year Again: Affordable Care Act’s Annual Open Enrollment Period Begins
It’s that time of year again: In most states, the Affordable Care Act’s annual open enrollment period for health plans begins November 1 and lasts through January 15.
Don’t Fall for Advertising Scams
While some health plans offer small-dollar gift cards or other incentives to encourage participation in wellness efforts, they would not offer cash cards worth thousands of dollars a month to help with groceries, gas, or rent. Even so, social media and online sites are rife with such promises. Such ads are among the avenues allegedly used by unscrupulous brokers who enroll or switch plans without the express permission of consumers, according to a lawsuit filed in Florida.
Beware of Unofficial Marketplaces
Type "Obamacare" or "cheap health insurance" into a search engine and often what pops up first are sponsored private sector websites unaffiliated with the official state or federal government marketplaces for ACA coverage. While they may try to look official, they are not. Many such sites offer various options, including non-ACA coverage with limited benefits, a "secret shopper" study found in 2023. Such non-ACA coverage would not qualify for federal subsidies to help consumers pay premiums.
Is It Real Insurance?
Another concern: Regulators are seeing an increase in complaints from consumers about offers of health coverage requiring consumers to join a limited liability corporation, or otherwise attest they are working for a specific company. Indeed, at least two states – Maryland and Maine – have issued warnings, saying that instead of comprehensive ACA coverage, these are often non-ACA products, amounting to a hodgepodge of discount cards, for example, or limited-indemnity plans. This type of plan pays a flat-dollar amount – say, $50 for a doctor visit or $1,000 for a hospital stay – and is meant to buttress more comprehensive coverage, not replace it.
Premiums Might Be Higher … and Other New Things
Some insurers will lower premium rates for 2025, but many others are increasing them. Although final numbers are still being crunched, experts estimate a median increase of 7% for premiums, according to an analysis by KFF. Most people who buy ACA coverage are eligible for a subsidy to help with the premiums, which is likely to offset much of the increase, although the higher cost means the government will be paying out more for those subsidies.
The Sign-Up Process Might Take Longer, Too
Federal regulators this year wrestled with a growing number of complaints – 200,000 in the first six months alone – from consumers who were being enrolled into or switched from ACA plans without their express permission by agents seeking to gain commissions. To thwart such efforts, they put new rules in place. What does that mean for most consumers? If you are working with a new agent – one who wasn’t already listed on your ACA plan – you will likely need to get on a three-way call with the federal marketplace to confirm that you are, indeed, authorizing that agent to make changes to your policy for the coming year. Plan on this taking additional time.
Shop Around
Experts say another consideration when choosing a plan is to check whether its network includes the doctors and hospitals you typically see, as well as whether its formulary covers your prescription medications, and how much it charges for them. To help with making comparisons, rules kicked in two years ago requiring insurers to include some “standardized plans” as options, which must all have the same deductibles, and costs for such things as doctor visits, emergency room care, and other consumer cost sharing.
Conclusion
To ensure a smooth and successful enrollment experience, it’s essential to be aware of the potential scams and pitfalls and take the necessary precautions. Start by exploring the official federal marketplace’s website, healthcare.gov, and selecting your state from the drop-down list. Be cautious of unofficial marketplaces and unscrupulous brokers who may try to capitalize on your willingness to enroll in a health plan. Remember, shopping around and comparing different options is crucial to find the best plan for your needs.
Frequently Asked Questions:
Q: What is the open enrollment period for the Affordable Care Act?
A: In most states, open enrollment begins November 1 and lasts through January 15.
Q: What happens if I don’t update my information or select an alternative during the open enrollment period?
A: Current enrollees who do not update their information or select an alternative will be automatically reenrolled in their current plan or, if that plan is no longer available, into a plan with similar coverage.
Q: What are some potential changes to look out for during the open enrollment period?
A: Some insurers will lower premium rates for 2025, but many others are increasing them. Additionally, some non-ACA products may be available, which would not qualify for federal subsidies to help consumers pay premiums.
Q: How can I protect myself from scams during the open enrollment period?
A: Be cautious of unofficial marketplaces and unscrupulous brokers who may try to capitalize on your willingness to enroll in a health plan. Start by exploring the official federal marketplace’s website, healthcare.gov, and select your state from the drop-down list. Also, be sure to carefully review any information and formal agreements before providing your personal information or signing up for a plan.
