Enrollment in the Affordable Care Act (ACA) health insurance marketplaces is down about 13% from last year—raising the potential for more people to be uninsured in 2020. But physicians have an opportunity to help spread the word and ensure that patients and their families have the health coverage they need in the new year.

As of Nov. 16, about 1.7 million people had enrolled in a marketplace plan using the Healthcare.gov platform, down from 1.9 million at the same time last year.

Due to significant federal budget cuts to ACA outreach and marketing efforts, your patients may not be receiving the information they need to know about enrolling in an individual marketplace plan, and importantly, about the financial assistance available that lowers premiums and cost-sharing responsibilities.

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There is still time to select a plan before the Dec. 15 deadline, and it is critical that physicians get the word out.

Here are three messages to relay to patients.

It is not too late to sign up. Uninsured Americans and people interested in exploring their coverage options for 2020 have until Dec. 15 to enroll on the HealthCare.gov website. There some exceptions to that deadline, as follows:

  • California—Jan. 31
  • Massachusetts—Jan. 23
  • Rhode Island—Dec. 31
  • New York—Jan. 31

In these 11 states and the District of Columbia, patients won’t use HealthCare.gov to shop for an ACA marketplace plan, but instead use a state-run website.

Do not just automatically repeat what you signed up for last year. Automatic reenrollment does keep patients covered, but better plans with more coverage and/or a more affordable price may be available.

Nationally, the average unsubsidized premium for the lowest-cost bronze, silver, and gold plans are decreasing by just under 3% from 2019 to 2020, and the average benchmark silver premium—on which subsidies are calculated—is dropping by somewhat more, by about 3.5%. 

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The Kaiser Family Foundation (KFF) reports that the average monthly benchmark silver plan premium price for a 40-year-old individual—before any applicable premium tax credits are applied—will be $462 in 2020, compared with $478 in 2019, the KFF calculated.

Price varies widely by geography, however, and a KFF report highlights that unsubsidized premiums for benchmark silver plans in Canadian County, Oklahoma, were dropping by 28%, while similar plans in Allamakee County, Iowa, were going up an average of 6%.

Check this list before sitting down to reenroll. Patients should follow this checklist of the 10 things needed to complete enrollment in the individual marketplace. These include Social Security numbers, birthdates and mailing addresses for everyone applying for coverage.

Other important points to note

Subsidies are still available to help consumers purchase marketplace plans, but qualifying income levels change year to year. In addition, California, a new state law provides qualifying individuals with state subsidies that may be in addition to federal subsidies, and extend to income levels too high to currently qualify for federal subsidies.

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So, even though a patient was not eligible for subsidies years ago when they last checked, they may be eligible in 2020. Also, patients currently eligible for subsidies may be eligible for a different amount of assistance for 2020 coverage.

New this year are “window-shopping” tools that allow website users to compare plans without logging on or creating a HealthCare.gov account. About 551,000 have used the English-language version of this tool, while about 16,200 have used the Spanish version.

The original purpose of short-term limited duration plans was to serve as a very temporary bridge between plans offering meaningful coverage, thereby preventing destabilization of the ACA marketplaces and ensuring individuals are in health plans that cover pre-existing conditions. However, as the result of a  new federal rule, STLDI plans can now provide coverage for up to 12 months. The plans have been criticized as “junk insurance” and were the subject of a Congressional hearing in March.

The American Psychiatric Association (APA) was involved in a suit seeking to block implementation of the rule. The Litigation Center of the American Medical Association and State Medical Societies joined the Medical Society of the District of Columbia in filing an amicus brief supporting the APA in the U.S. Court of Appeals for the District of Columbia.

The brief cites a KFF study of STLDI plans that found:

  • 43% of the plans studied do not cover mental health services.
  • 62% do not cover services for substance-use disorder treatment.
  • 71% do not cover outpatient prescription drugs.
  • None of the plans studied cover maternity care.
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