Open Enrollment for 2018 Individual Insurance: What You Need to Know

New Dates, Reduced Advertising, and Reduced Enrollment Assistance

Applies to individual coverage. © Verywell, 2017

Open enrollment for 2018 individual market coverage—both in the exchange and off-exchange—is just around the corner. It starts on November 1, 2017, and in most states, it ends just over six weeks later, on December 15.

This is much shorter than open enrollment has been in previous years and half as long as open enrollment was originally scheduled to run this year. It will also be the first time that open enrollment ends before the beginning of the new year.

There are a variety of changes and things to be aware of as we head into the fifth open enrollment period. And the executive order that President Trump signed on October 12 has added to the confusion that has plagued health care reform in 2017. But it merely directs various government agencies to make recommendations for changes that could be implemented to achieve the Trump Administration's goals. It doesn't have any immediate effect, and as far as open enrollment for 2018 coverage, nothing is changed with the executive order.

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Budget Changes

In addition to a shorter open enrollment period, the Trump Administration has slashed outreach and marketing funding for HealthCare.gov, which will result in far less advertising for the exchange and fewer in-person assisters who can help people enroll. 

Covered California analysis finds that the reduced funding is likely to result in one million fewer enrollees in HealthCare.gov states in 2018.

And since it's the healthiest enrollees who are likely to forgo enrollment, premiums will have to continue to rise to cover an increasingly sick pool of people.

The U.S. Department of Health and Human Services (HHS) is only spending $10 million on marketing for HealthCare.gov this fall, down from $100 million last year.

For perspective, California—which has its own exchange—is planning to spend $111.5 million—more than 11 times as much as HHS will spend to market HealthCare.gov, despite the fact that HealthCare.gov enrolled nearly six times as many people for 2017 as Covered Calfornia did. The Trump Administration has also reduced the budget for Navigator organizations (enrollment assistance) by 41 percent.

The combination of a shorter enrollment period, far less marketing, and less available enrollment assistance could result in a confusing experience for individual market enrollees this fall. So, let's take a look at the changes and what you need to know if you buy your health insurance in the individual market.

Timing

In most states, if you're signing up for individual market coverage—on or off-exchange—for 2018, you'll have a little over six weeks to complete your enrollment or make changes to your existing coverage. This is half as long as you've had during the last few open enrollment periods. HHS changed the dates in April 2017, cutting the scheduled enrollment window in half.

Open enrollment starts November 1 in every state and ends on December 15 in all but nine states. Unless you're in one of the states that has extended open enrollment, you won't have an opportunity to enroll or make changes to your coverage after December 15 without a qualifying event.

Further compressing the enrollment window, HHS announced in a training session in late September that HealthCare.gov, the exchange enrollment portal used by people in 39 states, will be unavailable due to scheduled maintenance for half the day on most Sundays during open enrollment, and even overnight on the first day of open enrollment, November 1.

This is a highly controversial move, and essentially reduces the open enrollment window by three full days. There could be changes to the planned outages before open enrollment. But people who have coverage through HealthCare.gov (or who need to purchase coverage for the first time) should plan ahead for the currently proposed downtime on the site, and plan to make any necessary coverage changes during a time that the website is scheduled to be online.

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 are about 17.6 million people in this market.

There are open enrollment windows that apply to people with Medicare and with employer-sponsored health insurance, but they are not affected by the changes the Trump Administration has made.

And people who have grandmothered or grandfathered individual market coverage are also not affected. 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 2018, particularly if you're eligible for premium subsidies or cost-sharing subsidies in the exchange.

What to Know Before Enrollment

This fall, 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—in the weeks leading up to open enrollment. 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 yearend 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.

In past years, 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 will no longer be available in 2018, 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

Nine state-run exchanges have opted to add additional time at the end of the regularly scheduled open enrollment period this fall/winter, and HHS has issued a special enrollment period for some hurricane victims in three states that use HealthCare.gov. Note that these are one-time extensions and will not apply in future years.

Exchange enrollees in these states will have until the following deadlines to enroll in coverage for 2018:

  • Connecticut: December 22 (all plans will be effective January 1)
  • Rhode Island: December 31 (all plans will be effective January 1)
  • Colorado: January 12 (the state has confirmed that this applies off-exchange as well)
  • Minnesota: January 14
  • Washington: January 15
  • Massachusetts: January 23 (enrollments submitted by December 23 will be effective January 1; enrollments submitted between December 24 and January 23 will have coverage effective February 1)
  • DC: January 31
  • California: January 31
  • New York: January 31

DC, California, and New York all opted to keep the open enrollment period that was originally scheduled for 2018 coverage. The other six exchanges picked earlier deadlines in an effort to get the earliest possible effective dates (January 1 or February 1) while still giving people additional time to enroll beyond the default December 15 deadline.

The flexibility to extend open enrollment is limited to states that don't use HealthCare.gov—and there are only 12 of them. Three of those 12 have not extended open enrollment as of mid-September—Vermont, Idaho, and Maryland. Vermont and Idaho have both said definitively that they intend to end open enrollment on December 15 and are not considering an extension.

In addition to the state-run exchanges that have extended open enrollment, HHS announced in late September that some residents impacted by Hurricanes Harvey and Irma will have until the end of December to enroll in plans through HealthCare.gov for 2018. This special enrollment period (December 16 - December 31) applies to people who reside in (or who resided in when the hurricane hit) one of the counties that FEMA deemed eligible for “individual assistance” or “public assistance” following Hurricanes Irma and Harvey.

That includes:

Enrollment Assistance

In addition to shortening open enrollment and slashing funding for HealthCare.gov marketing, the Trump Administration has cut funding for Navigator organizations by 41 percent compared with the funding they received heading into the open enrollment period in the fall of 2016. Finding enrollment assistance may be harder this year.

State-run exchanges run their own budgets for in-person assistance. For example, Connecticut's exchange is ramping up their in-person assistance 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. That didn't give insurers, exchanges, or consumers a lot of time to address the changes, which is why the market stabilization rule specifically notes that state-run exchanges have the option to use their own flexibility to extend open enrollment this fall.

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 is the Trump Administration's idea and is absolutely destabilizing for the individual market as it will result in fewer, and sicker, enrollees in 2018.

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 insurers exiting and entering the market each year, 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. This year, it is 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.

A Word From Verywell

We know that health insurance can be confusing, and 2017 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 2018 as it was in 2017.

Your premium subsidies and cost-sharing subsidies 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 there has been considerable uncertainty over the continued funding of cost-sharing subsidies (and premiums in many states have been adjusted upward to cover the cost of these subsidies in case the federal government stops paying for them), the subsidies themselves will continue to be available in 2018 to anyone all eligible enrollees. 

And despite repeated headlines about areas with no exchange insurers planning to offer coverage in 2018, every county in the country has at least one insurer lined up to offer exchange coverage.

The dates have changed for open enrollment in most states though, and the slashed advertising budget for HealthCare.gov means that people might not be aware of the shorter open enrollment window. So if you know someone who buys their own health insurance, spread the word!

Sign up at Healthcare.gov

Sources:

Department of Health and Human Services. Federal Register. Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2017. March 6, 2016.

Department of Health and Human Serices. Patient Protection and Affordable Care Act, Market Stabilization. April 2017.

Department of Health and Human Services. Policies Related to the Navigator Program and Enrollment Education for the Upcoming Enrollment Period. August 31, 2017.

Mark Farrah Associates. A Brief Look at the Turbulent Individual Health Insurance Market. July 19, 2017.

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