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OPEN ENROLLMENT FOR 2020: WHAT YOU NEED TO KNOW

By Numi Lee Griffith
High Value Health Care, Advocate

It’s that time again: Time to enroll in health insurance for next year.

Despite confusing messaging and continuing efforts to roll back consumer protections in Washington DC and the Courts, the Affordable Care Act remains in effect and Oregon’s Health Insurance Marketplace is still going strong.  Prices have kept steady and even gone down in some cases, while more counties have multiple plans available, and new tools have been released to help you shop.

Here’s our guide to Oregon’s open enrollment period, which runs from November 1 to December 15. Like the last two years, open enrollment is only available for these six weeks.  If you need individual insurance and do not have a plan selected by the end of this term, you will be unable to get comprehensive health coverage on the marketplace until next fall, except in very limited circumstances.

What’s New on the Marketplace in 2020?

  •  Choices in Every County: for the first time in years, every county in Oregon has at least two different carriers offering health insurance.  It’s a great time to see if you can get a better deal for 2020 than you’ve had in the past.

  • More Plans Offer First-Dollar Coverage: after changes to certain state rules, more plans than ever offer coverage before the deductible.  This means that you can start using your benefits immediately with just a co-pay, and you don’t have to meet your deductible first.

  • Window Shopping Tool: Oregon has launched a new “Window Shopping” tool this year, which can help you select a plan by showing your likely out-of-pocket costs under different plans.  This could be a better way for you to assess the differences between different company’s options instead of trying to dig through the numbers on Healthcare.gov.

Does this affect me and my family?

  • If you are currently uninsured, or if you purchase your own coverage, this is your chance to get covered, stay covered or shop around for better coverage.

  • If you purchased insurance through the Health Insurance Marketplace in 2019, you can renew your current plan or shop for another one at healthcare.gov. Plans and rates change every year, so we strongly recommend shopping around before renewing—there’s a good chance you’ll find a better deal.

  • If you currently have coverage through your job, through Medicare or another state or federal program, this open enrollment period does not affect you.

Where to go to get covered

  • Oregonians who need to buy health coverage on their own should go to healthcare.gov, the online marketplace for health insurance. All plans on the marketplace have comprehensive coverage, and you can’t be turned away or charged more for a pre-existing condition.

  • Many Oregonians will qualify for tax credits to help pay for coverage if they enroll through healthcare.gov. more about these tax credits here.

  • If you buy your own coverage directly from an insurance company, we also strongly recommend checking healthcare.gov before renewing your current plan or purchasing a new one, because you may be missing out on financial help that could save you and your family a lot of money. Studies have suggested that tens of thousands of Oregonians may be missing out on financial help—so even if you think you won’t qualify, it’s worth checking.

  • If you think you or anyone in your family may qualify for the Oregon Health Plan, check oregonhealthcare.gov  for information about eligibility and enrollment. There is no open enrollment period for the Oregon Health Plan and you may enroll at any time if you qualify.

Key Dates and Deadlines

  • November 1: Open enrollment begins.

  • December 15: Open enrollment ends.

  • You cannot enroll in health coverage through healthcare.gov  after December 15 unless you experience a special life-changing event such as having a baby—see here for info about your options if you miss open enrollment.

Using the Marketplace

  • To start the enrollment process and see if you qualify for tax credits to help pay for coverage, go to healthcare.gov and create an account. To do this, you need some basic information about yourself and everyone else you want to cover—for example, a spouse or children. See here for a checklist of info you may need.

  • Once you have created an account, healthcare.gov can let you know whether you or anyone in your family qualifies for tax credits or programs like the Oregon Health Plan.

  • At healthcare.gov, you can compare health insurance plans apples-to-apples in plain language. Without creating a user profile, you can “window shop” to see what plans would cost you with and without tax credits here.

Renewing coverage

  • If you enrolled through the Marketplace in 2019 and you are happy with your plan, you may be able to auto-renew. However, we strongly recommend taking the opportunity to shop around. Health insurance premiums change from year to year. For 2020, some premiums are increasing, and some insurers are changing their benefits and network designs. If you shop around, you may be able to find a better deal elsewhere.

  • If you are receiving tax credits to help pay for coverage this year, those credits may change next year, so make sure you look into all your options to make sure you’re getting the best deal and making the most of your tax credit eligibility.

  • If your personal circumstances have changed—for example, if you are making significantly more or less money, or if you have gotten married or had a baby—you need to report these changes via healthcare.gov, and your eligibility for tax credits or programs like the Oregon Health Plan may change, so you should be sure to shop around and look into all your options.

Tips for getting the best deal

  • Don’t just look at the premium. Out-of-pocket charges for health care services and prescription drugs can quickly break the bank if you aren’t careful, especially if you have health conditions that need regular medical attention. Plans with low premiums often have high out-of-pocket costs, so be sure to check co-pays, deductibles and co-insurance rates as well as premiums. Healthcare.gov includes an online tool that can provide a rough estimate of yearly out-of-pocket expenses for each plan as you shop.

  • To look into the details of costs and coverage for different services, check a plan’s Summary of Benefits and Coverage document, which is available via healthcare.gov.

  • Check out the plan’s network. Health insurance plans usually have a network of participating doctors and hospitals, and may not allow you to go outside that network, or may charge you more if you do. Some insurance companies may also have different networks for different health plans they offer. Some health insurance plans try to keep down costs by having very small networks that limit consumer choice. This is not necessarily a bad thing—it can save you money—but it’s important to make sure you know what you’re buying, especially if you have a relationship with a doctor that you want to keep.

  • You can find info on networks through provider directories, which are posted on insurance company websites. Healthcare.gov also includes an online tool that can provide some information about which medical providers participate in which plans as you shop. However, if access to a specific provider is critical for you, we would recommend contacting the insurance company and the provider directly to double-check, because these directories are not always entirely accurate or up-to-date.

  • Check out the plan’s prescription drug coverage. This is especially important if you have a prescription that you know you need. You can find general info the cost of drugs via the Summary of Benefits and Coverage, and healthcare.gov also includes an online tool that can provide some information about covered drugs as you shop. However, if you want detailed information about the cost of specific covered drugs, you will likely need to check the insurer’s formulary, which is available via the insurance company website.

We know that shopping for a health plan can be challenging, and we all know that health care still costs too much. At OSPIRG, we’re trying to do something about that, but we’ve still got our work cut out for us.

Getting Help with Enrollment

Still have questions, or confused about what to look for in a health plan?  Free help is available over the phone at 800-318-2596. You can search for local assistance, in person assistance through the Marketplace website.  The Marketplace also puts on enrollment events where you can get assistance or learn more about health insurance benefits.  You can use this calendar to find the best event for you to attend.

Please stay in touch as you shop for coverage and let us know about your experience. We are here to be your advocate.

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Medicare open enrollment is also underway, and ends December 7. If you have questions or require personalized assistance with Medicare open enrollment, contact Oregon's Senior Health Insurance Benefits Assistance Program (SHIBA) at 1-800-722-4134.

Graphics courtesy of Community Catalyst.

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