Health-care marketplace confusion — here are all of the facts

Time is running out. Open enrollment for health insurance plans has less than two weeks to go. But which plan is right for you and your family? A number of changes have happened since last year, and it’s important you understand your options. That’s why our organizations, representing patients, hospitals, and insurance providers, have come together — to make sure you have the facts you need.

First, let’s look at what hasn’t changed. The HealthCare.gov marketplace will be open through December 15, so you can buy a plan for 2019. If you’re eligible for financial aid, you can still apply through the Marketplace for help paying your premium and lowering out-of-pocket costs for copays and deductibles.

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You will generally have more choices through the marketplace than in past years. Every county in the United States will have at least one plan on the marketplace. Rates are more stable this year, so increases are generally lower than in the past. In some markets, premiums have even gone down.  

So, what’s new this year? In addition to the marketplace plans, consumers may now have two additional choices: short-term, limited-duration plans (though it is likely short-term plans will be sold under another name) and association health plans. These plans are not available through the Marketplace. While these new plans may have a lower premium, what they cover could be more limited. It’s important to know what you’re buying:

  • Short-term plans and association plans do not have to cover everything that is covered by Marketplace plans. For example, they may not cover the treatments and prescriptions your family needs.
  • Short-term plans may not cover preventive care like health screenings, some prescription drugs, mental health care, maternity care, or care for a chronic condition like diabetes or heart disease.
  • Short-term plans do not have to cover pre-existing conditions.
  • If you buy a short-term plan but find that you need more comprehensive coverage, you can’t enroll in a Marketplace plan until the next annual open enrollment period.
  • If you buy a short-term plan or an association health plan outside of the marketplace, you won’t be able to use federal financial aid to help you pay the premium or lower your deductible or copays.
  • Association health plans are not available to everyone. To buy an association health plan, you must be a member of a group that is permitted to buy that plan. For example, you may need to be a member of a specific profession.

No one plans to get sick or injured — and without good coverage, something unforeseen like a cancer diagnosis could lead to unexpected costs for your family. You want to be sure you have coverage that will take care of you and your family. When you consider how much your plan will cost, think about the total costs. How much will you be paying for premiums, deductibles, and copays all together? That will give you a real sense of the true cost of your coverage.

Some state marketplaces may have extended open enrollment periods, so check with your state Marketplace for exact dates. Be sure to check the site regularly, compare different plans and shop around, and re-verify how much financial assistance you’re eligible for. This is important even if you were covered in 2018.

Consider what you need today, and how you would be able to handle an emergency. Be sure your doctor is in the network of any plan you choose, and that the plan covers all your prescriptions. By doing some homework, you can help avoid surprise expenses in the future.

Marc M. Boutin, JD, is the CEO of the National Health Council, which is the united voice for patients with chronic diseases and disabilities and their family caregivers. Matthew Eyles is president and CEO of America’s Health Insurance Plans (AHIP), the national trade association representing health insurance providers. Richard Pollack is president and CEO of the American Hospital Association, which is the national organization that represents and serves all types of hospitals, health care networks, and their patients and communities.