What to Expect When You’re Enrolling: A Preview of Open Enrollment Season 4

In a few short weeks November 1 will mark the fourth year of open enrollment for ACA marketplaces. With each new enrollment season, marketplace officials have tried to improve consumers’ shopping experiences with tools to help them select and compare health plans. Here’s what we know so far about the tools available this year on marketplaces using healthcare.gov.

The Out-of-pocket Calculator allows consumers to estimate their total health care costs for the year, including premiums and out-of-pocket costs like deductibles and copayments, based on a projection of how much medical services they may use. The tool allows consumers to choose from low, medium, and high expected medical care, as characterized below.*

Low Medium High
3 Dr visits 7 Dr visits 18 Dr visits
1 lab or diagnostic tests 3 lab or diagnostic tests 11 lab or diagnostic tests
5 prescriptions 11 prescriptions 32 prescriptions
Minimal other medical expenses Minimal other medical expenses Minimal other medical expenses

* as of Oct. 6, 2016 on healthcare.gov for 2016 plans

The Doctor Lookup & Prescription Drug Check allows consumers to see what doctors are available in plans and whether a health plan covers a prescription drug. These features will be available in all states using healthcare.gov from the beginning of open enrollment, unlike last year when these tools were rolled out over the course of the open enrollment season, after more limited pilot testing.

Simple Choice Plans are new to the marketplaces this year and are standardized plan designs with fixed cost-sharing amounts like deductibles and copays. Standardized plans allow consumers to make more of an apples-to-apples comparison since out-of-pocket costs for the same services will be the same across plans in the same metal tier. Health plans are not required to offer these standardized plans, but if they do, they will be featured prominently on healthcare.gov. Shoppers will have the option to filter health plans by Simple Choice Plans on a landing page, which explains what Simple Choice Plans are to consumers. These standardized plans will be highlighted with a blue tag stating “Simple Choice” so consumers can easily identify them. It’s not yet clear how many health plans will be offering Simple Choice plans, but at least four insurers in Wisconsin will be offering these types of plans.

Like last year, consumers will also be able to use the filtering function on healthcare.gov to narrow down health plans based on certain preferences. Current filtering features include monthly premiums (less than $100, $200, and $300), metal tiers, plan types (PPO or HMO), medical management programs (e.g., asthma, heart disease, low back pain, weight loss or pain management), and insurance companies.

Perhaps the most important tool for consumers available again this year will be navigators, assisters, and brokers, who assist consumers looking to enroll or re-enroll into marketplace coverage. As we’ve noted before, these assisters play a key role for consumers wanting to get and use coverage.

As we’ve blogged about previously, two tools that won’t make it marketplace wide this year are the quality rating and network breadth tools, which will only be piloted in a few states. The quality rating tool will only be available in Virginia and Wisconsin (down from the previously announced 5 states) and the network breadth tool will only be available in four states – Maine, Ohio, Tennessee and Texas.

The marketplace is making an effort to make shopping for health plans easier for consumers. And while the marketplace may not quite be ready for its varsity letter in shopping tools, it’s made some significant improvements in the last three years.

2 thoughts on “What to Expect When You’re Enrolling: A Preview of Open Enrollment Season 4

  1. Pingback: Consumer Shopping on Healthcare.gov During Open Enrollment 4 - Center on Health Insurance Reforms

  2. Pingback: Everything You Need to Know About Healthcare Open Enrollment - Tech Pubs

Leave a Reply

Your email address will not be published. Required fields are marked *