Insurance Open Enrollment Round 2: What to Expect

By Lisa Zamosky
WebMD Health News

Reviewed by Sarah Goodell

Nov. 10, 2014 -- As we head into the second open enrollment period under the Affordable Care Act, consumers will see a revamped Healthcare.gov that government officials say will be easier to use. But with provisions of the law set to take effect for the first time this year, new challenges also lie ahead.

Consumers have between Nov. 15, 2014, and Feb. 15, 2015, to select or change health plans -- half the time they had under the health law's first open enrollment period. Those interested in a Jan. 1 start date for a new policy must make their selection by no later than Dec. 15.

Healthcare.gov is expected to work more smoothly than last year, when the Marketplace was plagued by technology problems. Most new customers will see a streamlined application featuring 16 rather than 76 pages this year, which is expected to simplify enrollment.

At the same time, the government has yet to finish the "back end" of Healthcare.gov, which is used to enroll consumers in health plans and send subsidy payments to insurers. Problems with the transfer of information between the Marketplace and insurance companies could mean delays and confusion for people whose health plans don't properly receive data about their enrollment choices.

"They are finding the same kind of issues they found last year, but they have a better awareness of why those issues are there," says Sumit Nijhawan, CEO of software company Infogix. "It's probably going to take a couple of years before that's ironed out."

One new concern is for people who decide to switch to a different health plan for 2015. Although officials say they're working on a fix, problems with the web site may prevent insurers from getting information about those who decide to switch to a new plan for next year -- and that could result in consumers being double-billed if they don't take it upon themselves to cancel their old policy.

At the same time millions of Americans are expected to shop for insurance for the first time, those who purchased coverage last year are being encouraged to return this open-enrollment season. That's so they can update personal information and shop their health plan options for a better deal.

"Last year it was about awareness, and this year it's about making sure you're getting the right plan for your family," says Carrie McLean, customer service director for eHealth.

The Congressional Budget Office expects that roughly 13 million people will be enrolled through the Marketplaces during 2015, adding about 6 million more to the current count.

Approximately 85% of those who enrolled in health insurance through the Marketplaces last year qualified for subsidies to help lower their health insurance costs. According to the Obama administration, on average, Americans getting subsidies saw their insurance costs slashed by an average of 76%.

Consumers nationwide will see new health plan options this year. The Department of Health and Human Services recently announced a 25% increase in the number of insurers offering Marketplace coverage in 2015, which is expected to increase competition in many, though not all, parts of the country.

Rate Changes and Subsidies

Rate increases are expected to be moderate, with average premiums for individual market health plans rising by about 6% for 2015 plans as compared with 2014, according to a PricewaterhouseCoopers Health Research Institute analysis.

Premiums can vary a lot, though. Average rates among the plans PricewaterhouseCoopers surveyed ranged from a 22% decrease to a 35% increase compared with 2014 rates.

Another analysis by researchers at the Urban Institute examined the rates of just silver-level health plans in 17 states and the District of Columbia. In most of areas, according to the report, people will have access to silver-level "coverage at lower rates than were available in 2014 or at premium increases of less than 5 percent." But people will likely need to switch plans to take advantage of the best deal.

Other plan details and costs are likely to change too, such as consumers' access to doctors and medications, and how much they must pay when they go for care, says JoAnn Volk. She's senior research fellow with the Georgetown University Health Policy Institute.

Consumers, she says, need to check everything again this time around by returning to shop the Marketplaces. "Check the formulary. Check the provider network. And the cost-sharing may have changed, too," she says.

Many people complained this year about Marketplace health plans restricting access to doctors and hospitals with the use of more limited provider networks and by getting rid of coverage for non-participating doctors. These cost-control measures employed by insurers are expected to continue.

Those with health plans who don't return to the Marketplace during open enrollment will be automatically re-enrolled in their current policies, as long as they're still offered.

But for subsidies, it's a good idea to return and double-check your info, McLean says.

Without doing so, most consumers will receive the same premium subsidy in 2015 that they received in 2014. Any changes to income or household size not reported to the Marketplaces may cause you to either miss out on additional subsidies for which you're eligible, or accept too much financial help from the government -- which you'll be required to pay back at tax time.

In some cases, consumers whose income has changed since last open enrollment may see an automatic end to the financial help after Dec. 31, 2014, unless they return to the Marketplace to update their personal information.

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SOURCES: C-SPAN: "Secretary Burwell on Health Care Policy." Sumit Nijhawan, CEO of software company Infogix. Association of Health Insurance Plans. Carrie McLean, customer service director, eHealth. Congressional Budget Office. Press release, U.S. Department of Health and Human Services. PwC 2015 Rates. Urban Institute: "Marketplace Insurance Premiums in Early Approval States." JoAnn Volk, senior research fellow, Georgetown University Health Policy Institute.

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