Open Enrollment for 2019 Individual Insurance: What You Need to Know

Same Dates, But Further Reduction Enrollment Assistance

Open enrollment for 2019 individual market coverage—both in the exchange and off-exchange—will begin November 1, 2018, and end just over six weeks later on December 15, in most states.

This is the same schedule that was used in most states for 2018 coverage, although it's only half as long as previous years' open enrollment periods. As was the case for 2018, open enrollment will end before the 2019 plans take effect, so enrollees won't have a chance to change their minds about their coverage after it takes effect.

Some of the upheaval and uncertainty that plagued the individual market heading into 2018 has been resolved, but there are additional issues that have cropped up in the meantime. The insurance markets are generally more stable and profitable than they were in 2017, but the Trump Administration is continuing to take actions that undermine the stability of the market. And the fact that Congress repealed the individual mandate penalty, starting in 2019, has also had a detrimental effect on the insurance markets.

Health insurance premiums for 2019 will be higher as a result of these actions than they would otherwise have been, but the rate hikes for 2019 are generally shaping up to be much more modest than the eye-popping rate hikes that applied in many states for 2018.

This is despite the fact that the Trump Administration has been working to expand access to short-term health plans and association health plans, both of which are expected to appeal to healthy enrollees. When healthy enrollees leave the ACA-compliant market, the risk pool becomes less healthy overall, and rates tend to increase. But there are indications that association health plans might not be as popular as the Trump Administration had assumed. And although insurers are mentioning association health plans and short-term plans as reasons for the rate hikes they've proposed for 2019 (along with the impending elimination of the individual mandate penalty), the impact isn't shaping up to be as significant as originally expected.

The federal government is continuing to not fund cost-sharing reductions, but that's no longer an uncertain factor for insurers, since they know what to expect. In most states, insurers are adding the cost of CSR to silver plan premiums, which results in larger premium subsidies. In many cases, bronze and gold plans are particularly affordable due to the disproportionately large subsidies that can be used to offset the premiums (people who aren't eligible for premium subsidies can pick a non-silver plan, or, in many states, a silver plan sold outside the exchange, and avoid having to pay premiums that include the cost of CSR).

Further Cuts to the Navigator Program Budget

In the weeks leading up to open enrollment for 2018 coverage, the Trump Administration slashed outreach and marketing funding for HealthCare.gov, resulting in far less advertising for the exchange and fewer in-person assisters to help people enroll. 

The U.S. Department of Health and Human Services (HHS) only spent $10 million on marketing for HealthCare.gov in the fall of 2017, down from $100 million the year before. For perspective, California—which has its own exchange—was planning to spend $111.5 million—more than 11 times as much as HHS spent to market HealthCare.gov, despite the fact that HealthCare.gov enrolled nearly six times as many people for 2017 as Covered Calfornia did (34 states rely on HealthCare.gov's marketing budget).

The Trump Administration also reduced the budget for Navigator organizations (enrollment assistance) by 41 percent in the fall of 2017. The Navigator budget had been $63 million in the fall of 2016, and was reduced to $36 million in 2017.

In July 2018, CMS announced another drastic cut to the Navigator funding budget, reducing it to just $10 million across all 34 states that receive grants.

The ostensible justification for the Navigator funding cut was based on the fact that Navigators have enrolled a fairly small percentage of the people who have signed up for private plans in the exchanges, and on the assumption that as time goes by, people need less help with the enrollment process.

But as Kaiser Family Foundation points out, public awareness about the enrollment process remains fairly low among people who are uninsured and those who buy their own coverage. And although Navigators don't enroll large numbers of people in private plans, their assistance is invaluable when it comes to Medicaid enrollment (which isn't counted when the groups are judged in terms of their total enrollments). And many Navigator organizations also partner with volunteer enrollment counselors, but the enrollments facilitated by those volunteers also are not counted. In short, the assistance provided by Navigators is more than it appears at first glance, and the drastic funding cuts (which are more severe in some states than in others) will reduce the amount of assistance that's available to people signing up in the fall of 2018.

With all that in mind, let's take a look at what you need to know this fall if you buy your health insurance in the individual market.

Timing

In most states, if you need to buy individual market coverage—on or off-exchange—for 2019, you'll a little over six weeks to complete your enrollment or make changes to your existing coverage.

In almost all states, open enrollment will start November 1 and end on December 15. As of July 2018, two state-run exchanges (California and DC) had announced extended enrollment schedules, and other state-run exchanges might opt to follow suit. But unless you're in a state that opts to extend open enrollment, you won't have an opportunity to enroll or make changes to your coverage after December 15 without a qualifying event.

If your insurer exits the market at the end of 2018, you'll have a special enrollment period (the first 60 days of 2019) during which you can pick a new plan. But as of July 2018, there haven't been any announcements of carriers planning to exit markets at the end of 2018. This is in sharp contrast with the situation for 2017 and 2018, when numerous carriers exited exchanges across the country. The lack of insurer exits for 2019 (and the fact that insurers are joining the exchanges or expanding their coverage areas for 2019) is indicative of improving market stability.

Available Coverage

The November 1 through December 15 open enrollment window applies to individual market coverage that's compliant with the Affordable Care Act (ACA, aka Obamacare), both on and off-exchange. According to an analysis by Mark Farrah Associates, there were about 17.6 million people in this market in 2017, but enrollment has declined (mostly among people who don't receive premium subsidies, including everyone who enrolls off-exchange) in 2018.

There are open enrollment windows that apply to people with Medicare and with employer-sponsored health insurance, but they are separate from the enrollment periods that apply in the individual market, and are not affected by any of the funding cuts, timing changes, or state-specific extensions.

People who have grandmothered or grandfathered individual market coverage are also not affected by any changes related to open enrollment. Those plans are no longer available for purchase and thus do not have applicable open enrollment windows.

However, if you have a grandmothered or grandfathered plan, it's absolutely in your best interest to see how it compares with the ACA-compliant plans that will be available for 2019, particularly if you' d be eligible for premium subsidies or cost-sharing subsidies in the exchange.

What to Know Before Enrollment

It's particularly important that you pay attention to the communications you receive from the exchange—or from your insurer if you have off-exchange coverage. Make sure you understand how much your premium is going up, and if you have a premium subsidy through the exchange, understand how much your after-subsidy premium will change.

Pay attention as well to the coverage details summarized in the renewal information you get from your insurer and/or the exchange. Insurers can terminate a plan at year-end and "crosswalk" or "map" enrollees to a new plan with similar—but not identical—benefits. Exchanges can also do this if an insurer is leaving the exchange altogether.

Prior to 2018, people had a chance to make changes to their coverage in January if they were caught off-guard by a higher premium or coverage changes at the start of the new year. That opportunity is no longer available in most states, so it's essential to make sure you understand the details before mid-December and make any changes that you deem necessary.

States With Extended Enrollment

There are 12 fully state-run exchanges that run their own enrollment platforms and thus have the option to add additional time before or after the regularly scheduled open enrollment period. For 2018 coverage, ten of the 12 opted to do so. Only Vermont and Idaho stuck with the November 1 - December 15 schedule.

For 2019, DC and California will have longer open enrollment periods, and some other state-run exchanges might opt to extend open enrollment as well.

Enrollment Assistance

After cutting funding for Navigator organizations by 41 percent in the fall of 2018, the Trump Administration opted for another drastic Navigator funding cut prior to the open enrollment period for 2019 coverage. Navigator organization received a total of $63 million in 2016, spread across 34 states. In 2018, they're receiving just $10 million. So finding enrollment assistance may be harder than it's been in past years.

State-run exchanges run their own budgets for in-person assistance. For example, Connecticut's exchange ramped up their in-person assistance in 2017, with various new locations throughout the state. But the majority of the states rely on the federally-run exchange and won't have as much funding this fall for in-person enrollment assistance.

If you think you might need help selecting a plan or enrolling, it's wise to make an appointment ahead of time with a broker or navigator in your area or to find out what organizations in your community will have certified enrollment counselors on hand during open enrollment.

Reasons for Shorter Enrollment

It's important to understand that the shorter open enrollment period, which is part of a market stabilization effort, was actually planned under the Obama Administration, and was slated to take effect in the fall of 2018. The Trump Administration only moved that up a year, having it take effect in the fall of 2017 instead.

The move to shorten open enrollment starting in the fall of 2017 was part of the market stabilization regulation that HHS finalized in April 2017. The idea was that insurers need to have as many people as possible enrolled in full-year coverage in order to keep the risk pool stable, and ending open enrollment before the end of December is the means to achieving that goal.

In previous years, when open enrollment continued into the new year, people could enroll in coverage in late January and have a March 1 effective date. That meant they were only paying premiums for 10 months of the year, rather than 12.

Sick people are not likely to do this. It was healthy enrollees—the people who are most needed in the risk pool in order to keep it stable—who were signing up for partial-year coverage. Insurers and the exchanges knew this wasn't sustainable and the shorter open enrollment period is a means of addressing the issue.

And again, HHS, under the Obama Administration, had come to the same conclusion in regulations that they finalized in early 2016. But the plan at that point was to give insurance companies, exchanges, and consumers more time to prepare for the shorter open enrollment period as it wasn't slated to take effect until the fall of 2018.

Instead, the new dates were rolled out in April 2017, just a little over six months before the start of open enrollment for 2018 coverage.

it's also essential to note that the Obama Administration was not planning to cut funding for exchange marketing and enrollment assistance, which the Trump Administration did in tandem with the expedited shortening of the enrollment period.

Understanding the Controversy

The concept of a shorter open enrollment period that ends in December, with all plans effective January 1, was controversial even when HHS under the Obama Administration proposed it in late 2015. HHS discussed the dissenting opinions in the regulation that they finalized in early 2016.

So, although President Trump has repeatedly said that he'll "let Obamacare implode," the shorter open enrollment period was not the Trump Administration's idea, and the controversy that surrounds it now already existed before Trump won the 2016 election. But the reduced funding for marketing, outreach, and enrollment assistance was the Trump Administration's idea and is potentially destabilizing for the individual market. There were concerns that enrollment would be much lower in 2018 than it had been in 2017, although enrollment ended up only slightly lower (and slightly higher when we only look at effectuated enrollments, although you can't really compare apples to apples for effectuated enrollment in 2017 and 2018, due to the different end dates for open enrollment).

Proponents of a shorter open enrollment period note that it helps to ensure that everyone has full-year coverage. They also believe that a three-month enrollment window is no longer necessary now that the exchanges are functioning smoothly and insurers and consumers are used to the new normal in the individual market.

But opponents of the shorter open enrollment window note that the individual market is volatile, which means that people cycle in and out of it from one year to the next and there are constantly new people needing to purchase individual market coverage for the first time. They also point out that the new window overlaps with the existing Medicare open enrollment period. And, many of the brokers who assist people in the individual market are also helping people in the Medicare market, stretching the assistance resources fairly thin.

The plans for sale in the individual market are also particularly volatile, with varying insurers in a given market from one year to the next, along with network and benefit changes. This makes it harder (and not generally advantageous) for people to "set it and forget it" when it comes to their individual market health insurance. It's important and often necessary to shop around each year, and the compressed enrollment window makes it more challenging for everyone in the individual market to be able to do that, particularly if they need assistance with the process.

Opponents of a shorter open enrollment window also note that sick people tend to sign up as soon as possible, early in the enrollment window. But young, healthy people (ie, the "young invincibles") are more likely to procrastinate and sign up at the last minute. So it's especially important to communicate to that population that open enrollment ends December 15 so that they don't wait too long and miss the window altogether.

What If I Have Coverage Through My Employer?

The open enrollment changes and provisions described above apply only in the individual health insurance market, so they don't affect people who get health insurance coverage from their employers. But if you have employer-sponsored health insurance, your open enrollment period may overlap with the individual market's open enrollment period.

Many employer-sponsored health plans hold their open enrollment periods in the fall, so that coverage changes can be effective on January 1 of the coming year. That's not always the case, however—your employer might have a plan that doesn't follow the calendar year, so your open enrollment might be a different time of the year. 

Open enrollment for employer-sponsored plans is often shorter than the enrollment window used in the individual market, but your employer will communicate the key dates that apply to your plan. Your employer may hold meetings for employees to prepare for open enrollment, or they may send personalized information to each employee. If you have questions, now's the time to ask. If you're unsure of any of the terminology used to describe the plans, ask for help before you make a decision.

Employees often stick with the same plan from one year to the next simply due to inertia—even when a better option becomes available. If your employer offers more than one plan option, it's worth your while to carefully consider each plan during open enrollment. Look at how much you'll pay in premiums (the amount that will be deducted from your paycheck), and how much you'll pay in out-of-pocket costs when you need medical care. Think about your recent health care spending, and consider any expenses you expect to incur in the coming year. If one of the other plan options will present a better value than the one you have now, open enrollment is your opportunity to switch plans, and your employer likely has a process in place that will make it easy to do so.

If you or any of your family members take prescription drugs or see a particular doctor, make sure you double check the covered drug lists (formularies) and provider network details for each of the plans your employer offers. If you switch plans and then find out after the new plan takes effect that your medications and/or doctor aren't covered, you'll have to wait until the next year's open enrollment to switch plans again.

What If I Miss Open Enrollment?

After open enrollment ends, your opportunity to enroll in health insurance coverage for 2019 will be limited. You'll be able to sign up mid-year if you experience a qualifying event (eg, loss of coverage, the birth or adoption of a child, etc.), and in most cases that applies to plans purchased in the exchange or directly from an insurance company. But it's important to note that some of the qualifying events, including moving to a new area or getting married, only trigger a special enrollment period if you already had minimum essential coverage in place before the qualifying event.

So if you miss the open enrollment period for 2018 coverage and don't experience a valid qualifying event later in the year, you won't be able to sign up for an individual market major medical health insurance plan until the next open enrollment period starts again in the fall of 2019 (coverage in that case would be effective January 2020).

A Word From Verywell

We know that health insurance can be confusing, and 2017-2018 has certainly added to that confusion with the constant debate over healthcare reform. But the overall structure of the individual market will be the same in 2019 as it was in 2018.

Your premium subsidies and cost-sharing reductions will still be available, and the exchanges in every state are functioning just the same as they were during the last open enrollment period.

Although the Trump Administration cut off funding for cost-sharing reductions in the fall of 2017, the impact of this (higher premiums—particularly for silver plans—in nearly every state) is being mostly borne by the federal government, in the form of larger premium subsidies. The cost-sharing reductions themselves will continue to be available in 2019 to anyone all eligible enrollees. 

The individual mandate penalty will no longer apply after the end of 2018 (unless you're in a state that has its own mandate penalty), but going without coverage isn't recommended, even after the federal penalty is eliminated. If you do go uninsured, you likely won't have an option to get coverage until 2020, and you'd be left uninsured if a medical emergency were to arise mid-year.

But the good news is that rate hikes for 2019 are shaping up to be less severe than they were for 2018, and insurers are joining the exchanges in many areas. Premium subsidies will be larger than ever, and bronze or gold plans will be particularly inexpensive in many areas for people who qualify for premium subsidies (since the cost of CSR is generally being added to silver plan rates, and subsidies are based on the cost of a silver plan). Open enrollment will run from November 1 to December 15 in most states, and it's your opportunity to sign up for a plan and take advantage of those premium subsidies if you're eligible. So if you know someone who buys their own health insurance, spread the word!

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