What You Need to Know to Enroll for Health Insurance for Next Year

By Allison Ivie

With the window set to open on the 2020 open enrollment period for Affordable Care Act (ACA) health insurance plans — from November 1 to December 15 — now is time to consider all options for yourself and your family.

And here's some good news as you do: Average premiums are expected to continue the declining trend first reported nationwide in 2019, following years of rising rates. (Between 2016 to 2018, individuals and families saw health insurance rates rise 25 percent to 30 percent.)

Experts say the cost savings to enrollees is due to insurers overestimating the impact of federal regulatory policy changes in previous years.

Shrinking Health Insurance Enrollment

Despite shrinking average premiums, the number of Americans without health insurance rose last year by 2 million people, or 8.5 percent last year, according to the U.S. Census Bureau. This marks the first year-to-year increase since the ACA took effect in 2010. The increase is troubling and is only expected to grow due to a number of health policy-related factors, including:

• Repeal of the individual health insurance mandate. Consumers no longer face a tax penalty for not having health insurance, prompting more Americans to forgo purchasing health insurance.
• Expanded availability of non-ACA plans. Recent years has seen the growth of short-term, limited duration health insurance plans (STLDI) offering minimal coverage for up to one year with an option to renew. The lowest cost STLDI plan can be as much as 20 percent lower in cost than a bronze ACA plan.

Changes to Medicaid requirements. Several states have changed or are working to change eligibility and reporting criteria under their state-based health care insurance programs, making it harder for individuals and families to qualify for such coverage.

Nevertheless, more Americans have health insurance now (91.5 percent) than prior to the ACA (86.7 percent).

What to Look For in 2020 Health Insurance Plans

For individuals and families looking to change their health plan next year, HealthSherpa, a private health insurance marketplace can help you shop and compare plans, determine whether you qualify for subsidized coverage, and enroll you in coverage.

When considering the health care needs of you and loved ones, it is important to remember the coverage benefits that come with ACA-compliant plans:

• No lifetime limits on coverage
• No annual benefit maximums
• Guaranteed issue (health insurance companies cannot deny you a health plan)
• 10 essential health benefits (includes pregnancy, maternity and newborn care, prescription drugs, and mental health and substance use disorder services)

What Is Short-Term Limited Duration Health Insurance?

If you're working with a health care broker, make sure you understand the limitations that come with short-term limited duration (STLDI) plans before committing to one.

While a STLDI health plan premium is typically much cheaper than that of an ACA-compliant plan, it's because STLDI plans offer significantly fewer benefits. For example, no STLDI plans provides maternity care while 71 percent do not cover outpatient prescription drugs.

Also important to consider when shopping around for the most health insurance protection at an affordable price is you may qualify to receive a subsidy for the purchase of an ACA-compliant plan. Most individuals and families do to help reduce monthly premiums and cover out-of-pocket costs.

Be sure to explore your eligibility for financial help before deciding on a plan that's right for you and your family.