ACA Open Enrollment = Confusion + Scams

October 15, 2024

What’s New and What To Watch For in the Upcoming ACA Open Enrollment Period
KFF Health News
October 8, 2024
By Julie Appleby

It’s that time of the year again: In most states, the Affordable Care Act’s annual open enrollment season for health plans begins.

Current enrollees who do not update their information or select an alternative will be automatically reenrolled into their current plan or, if that plan is no longer available, into a plan with similar coverage.

While some health plans offer small-dollar gift cards or other incentives to encourage participation in wellness efforts, they would not offer cash cards worth thousands of dollars a month to help with groceries, gas, or rent. Even so, social media and online sites are rife with such promises. Such ads are among the avenues allegedly used by unscrupulous brokers who enroll or switch plans without the express permission of consumers. Also, be cautious about the websites you use to search for coverage. Type “Obamacare” or “cheap health insurance” into a search engine and often what pops up first are sponsored private sector websites unaffiliated with the official state or federal government marketplaces for ACA coverage. While they may try to look official, they are not.

Another concern: Regulators are seeing an increase in complaints from consumers about offers of health coverage requiring consumers to join a limited liability corporation. These are often non-ACA products, amounting to a hodgepodge of discount cards, for example, or limited-indemnity plans. Some of these self-funded plans only cover preventive services such as a yearly check-up or annual health screening.

Short-term plans, which are technically not ACA coverage and not subject to its benefit rules and preexisting benefit protections, can be issued for only four months of coverage. Consumers who relied on the longer periods need to check their plans’ details and consider enrolling in an ACA plan instead to avoid a situation in which their short-term plan expires early or midyear, potentially leaving them unable to get coverage elsewhere for the remainder of the year.

Sorting through the dozens of options on the marketplace is challenging, so most people do seek assistance. Another consideration when choosing a plan is to check whether its network includes the doctors and hospitals you typically see, as well as whether its formulary covers your prescription medications, and how much it charges for them.

One piece of advice remains constant: Whether you are enrolling for the first time or have an existing plan, it’s always worth it to shop around.

 

Comment by: Don McCanne

Just a reminder: Of the high income nations appearing in the Commonwealth Fund report, the United States has the most expensive but poorest performing health care system of all.

What is ironic is that each year we are forced to reevaluate our existing health plans since the insurers frequently change the benefits or functioning of the plans, with changes usually accruing to the benefit of the insurers, and, at that, we may lose the option of keeping the plan we have. So, not only do we have the lousiest system, we may lose the option of keeping the benefits we do have, even if mediocre, or perhaps not even being able to select options that would be more appropriate for any change that could occur in our health status.

Being granted mostly poor choices amongst a dysfunctional system is certainly a contributor to the high expense and poor quality of our health care system. But we could have a much better choice, and that would be to elect government stewards who would enact and implement a vastly superior health care system that would greatly improve the value of our health care spending by funding it with progressive taxes, based on ability to pay, making it affordable for all with no negative impact on the lifestyles of the wealthy. All essential health care services would be accessible to everyone. Of course, that system would be a carefully redesigned, single payer, Medicare for All.

So it’s time to choose, but not from an overpriced, dysfunctional health care system, but rather from political candidates who understand the health policies that would bring us high quality care for everyone that is affordable for all.