Obamacare's fifth enrollment season opens Wednesday amid continued uncertainty over the fate of the health-care law — and concerns that confusion among customers and rising premium prices will reduce the number who sign up.
"Going into every open enrollment season it seems high stakes, but the stakes going into this open enrollment seem higher than ever before," said Obamacare expert Larry Levitt, a senior vice president at the Kaiser Family Foundation.
"We're going into an open enrollment period where the president is saying the law is dead, even though the law's benefits and requirements are still in effect," said Levitt.
The main requirement of that law, the Affordable Care Act, is that most Americans have some form of health coverage during the year or pay a tax penalty. The vast majority of people already have coverage through a job, Medicare or Medicaid and are in compliance with the law.
But for people who don't have such coverage, the ACA authorized the creation of government-run health marketplaces to sell individual insurance plans, as well as the expansion of Medicaid eligibility to more low-income adults.
Sign-ups for Obamacare individual plans that take effect Jan. 1 begin Wednesday on HealthCare.gov, the federal exchange that serves most of the country, and on the 12 exchanges that serve the remaining 11 individual states and the District of Columbia. A large percentage of Americans are unaware of the open enrollment start date, surveys have shown.
Open enrollment this season on HealthCare.gov states ends Dec. 15 — weeks or even months earlier than Obamacare's previous sign-up seasons.
Among the latest are California and New York, which have Jan. 31 deadlines.
If you haven't chosen an Obamacare plan by your state's deadline, you won't be able to do so until next fall, unless you qualify for a special enrollment period.
And people who lack coverage during the year face a penalty of the higher of 2.5 percent of household income or $695 per adult.
Lori Lodes, who oversaw Obamacare outreach efforts in the Obama administration, said that her message during past enrollment seasons and this one is the same for people who have an individual plan or who lack coverage: "Visit HealthCare.gov and shop."
HealthCare.gov will direct people to their proper state exchanges if the federal site doesn't serve their states, she noted.
Lodes said many people "think health coverage is out of reach, it's just too expensive."
But in reality, "coverage might be more affordable than you think," said Lodes, co-founder of Get America Covered, an Obamacare advocacy group started this year to counteract the Trump administration's negative messaging about the ACA. Get America Covered has put together its own primer on open enrollment, which can be seen here.
Many people qualify for federal subsidies, or tax credits, that can significantly reduce their premiums for Obamacare plans. More than 80 percent of HealthCare.gov customer get subsidies that lower their premiums.
The U.S. Health and Human Services Department, in a report Monday, said that 80 percent of HealthCare.gov customers would be able to find a plan for $75 per month or less, because of their subsidies. That's up from about 70 percent of customers in prior years.
In 2018, individuals who earn between about $12,000 and $48,240 annually qualify for such subsidies.
For a four-person family, subsidies are available if the household earns between $24,600 and $98,400.
Gaba, of ACASignups.net, said people should carefully check their eligibility for premiums on HealthCare.gov. He noted that income thresholds, which are linked to the official federal poverty level, rise every year.
"There are going to be a lot of people this year who may not have qualified for tax credits in 2017 who may be qualified this [next] year," Gaba said.
Premiums for many Obamacare plans that take effect in 2018 rose sharply.
Much of the increase in prices was due to threats by the Trump administration to stop paying insurers reimbursements for discounts to out-of-pocket costs the insurers must offer low-income Obamacare customers. The administration followed through on those threats in mid-October.
Customers who don't qualify for subsidies will be hit with the higher prices, in many cases.
However, the price hikes have created an unusual situation for subsidized customers and some nonsubsidized customers, one in which they will actually pay less for their insurance plans in 2018 than they did in 2017.
Subsidized customers are generally insulated either totally or mostly from the price hikes because their subsidies rise in value as the premiums increase.
And nonsubsidized customers may be able to find less expensive coverage than silver plans by opting for either bronze or gold plans.
Kev Coleman, head of research at the insurance comparison site HealthPocket, said that he tells friends, family and other people looking for Obamacare enrollment advice "not to limit themselves to just one source of shopping."
Coleman said that in addition to checking out HealthCare.gov or their state-run marketplace, customers should check out plans sold directly by insurance companies, brokers and internet-based insurance brokerages.
"Each one can have very distinct inventories" of individual health plans, Coleman said. "You have to look at all available options."
However, subsidies for Obamacare plans are only available to customers who buy a plan sold on the government-run exchanges, or through a web-based broker who sells such plans.
"Don't just shop on price alone," Coleman warned.
While bronze plans tend to be the lowest priced, they also have relatively high out-of-pocket costs when customers go to the doctor, get surgery or buy prescription drugs.
And plans might impose higher costs, or offer no coverage at all, for certain brands of drugs.
"People think 'all drugs are covered,'" Coleman noted. "No."
Another issue to consider, he said, is the size and design of a health insurance plan's network: the doctors, hospitals and other providers that are covered by the plan.
If a person has insurance, but ends up getting services from an out-of-network provider, the cost can be steep, or even onerous.