ACA Update: Dec 31 New Enrollment Deadline and Other Changes

As of this writing, the ACA – its common moniker, Obamacare, now gets bandied about as both a holy grail and a curse, depending on who you’re talking to – is still a thing. The current administration is working on undercutting it, so there is a high possibility of change coming – but what’s actually changed in the world of the Affordable Care Act for Rhode Islanders this year?

Rhode Island is one of a handful of states that chose to create a local exchange for insurance rather than simply funnel people through the national ACA website and process. It may sound provincial, but it turned out to be a pretty good decision. Although not without its hiccups, the local website outperformed the national one by many measures for the first few years, was up and running faster, and has given local government more control if they disagree with some of the national decisions – an element that might become extremely important over the next couple of years.

This year, marketing funds for our local exchange were dramatically cut, but that was part of the original plan – the theory there is that the ACA and our health exchange are no longer a new thing, so raising awareness isn’t a top consideration. The brand’s established, now the marketing is about reminding folks, which takes a lot less effort and investment.

Many costs have gone up, and this does take a bit of effort to wrap your head around. “With the changes and reductions to cost sharing this year, we are encouraging customers to actively shop. To come in or call and make sure they understand all of their options,” says Kyrie Perry, director of outreach and communications for HealthSourceRI. HealthSource launched a new calculator tool this year to help people look at all their contributing factors – network, total medical expense, family, income, age, etc. to give a “wholistic sense of their health costs and exactly what help they’re eligible for.” It’s at healthsourceri.com/calculator.

A big motivation for creating this tool was that changes in federal financial assistance have caused significant ripples of change in the pricing structure of many plans, especially the mid-tier “Silver Level” plans. “Some Silver Level plans are now more expensive than Gold Level plans. And that is pretty much the opposite of what we’ve been trying to do. Some people may have sticker shock … but financial assistance also increases – they need to understand what they’re eligible for, including deductibles and copays. The reason they weighted the increase only on the Silver Level plans is because financial assistance for the entire exchange population is based on the second-lowest-cost Silver Plan. So if that premium is higher, the financial assistance (the difference between the premium and what makes the plan affordable) also needs to increase. The definition of what makes a plan affordable … is roughly 9.5% of your income.” If you chose your plan in the past, the math has basically changed and is worth doing again.

The other substantial change is to open enrollment deadlines – the period during which you can reup. Past years cut off in mid-January. This year, it’s Dec 1 – Dec 23 if you want to be covered in January (enrollment between the 23rd and 31st doesn’t take effect until Feb 1). “Back when the Trump administration was trying to [sabotage] the Affordable Care Act, they proposed a rule that would shorten the federal open enrollment period to December 15. They did give the states with their own exchanges the flexibility to extend their open enrollment periods… So HealthSource worked with our carriers and the health insurance commissioner to extend open enrollment to December 31,” explains Perry. The carriers participating are Blue Cross Blue Shield of RI and Neighborhood Health Plans. United Health Insurance left the open exchange two enrollment periods ago – “They pulled out from the majority of state exchanges across the country – a trend among a number of insurers. It has almost everything to do with the current administration trying to make it as difficult as possible for people to get the health insurance they need.” Also helping Rhode Islanders stay insured is the allowance in RI’s system for automatic renewal, if your circumstances have not changed significantly since last year. Perry suggests reviewing your plan options this year, rather than just allowing the automatic renewal, however, because of the significant pricing changes mentioned above.

On the bright side, Rhode Island is knocking it out of the park on most of the local measures of success. “It’s wonderful – about 96% of Rhode Island is insured now,” Perry says, adding that precise numbers will be available in January. “We have the sixth lowest uninsured rate in the country. So far, we have [also] seen the number of new enrollees increase significantly… We have about three times the number of new enrollees as we had at this point last year.”

Motif: What’s spurring that? Is some of it a sense of, “We better get in before this option goes away?”

Perry (HealthSource): It could be … that’s not something we can measure. But we did start promoting the open enrollment period about a month earlier than in the past, because we became aware that the period would be shorter. I think that the Affordable Care Act has never been more popular than it is today [national polls show a growing acceptance of universal health care as a positive in the years since the ACA was put in place]. Finally, one of the benefits of the not-always-positive rhetoric around it [on the national stage] is that it’s made customers more educated. They understand what the advantage is to having coverage include pre-existing conditions. They’re more comfortable with the terms than they may have been in years past, because there’s been so much attention. For that reason, people are understanding the importance of having coverage.

Motif: So, in trying to tear it down they’ve to some small extent helped it.

Perry: It’s a positive side effect.

There is a walk-in center at 401 Wampanoag Trail, East Providence, where you can ask questions about your specific situation, and Blue Cross also now offers walk-in stores to help you understand their offerings and how to access them through the exchange – you can find a list of locations at bcbsri.com/yourbluestore. United Way’s 211 number can connect you to a trained “Navigator,” who can help you figure out your best solution, and HealthSource has enrollment events throughout the month of December, which you can learn about at healthsourceri.com/upcoming-events.

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