Open Enrollment on Healthcare.gov started this morning.
With the somewhat small exception of the Texas v Azar case that is currently hanging out at the 5th Circuit which, if affirmed, could throw out the entire law, I expect the open enrollment period to be fairly straightforward.
I expect total on-exchange enrollment to decrease by a few percentage points for a couple of reasons.
- Slightly worse pricing net of subsidy as spreads between Benchmark and cheapest plans compressed
- Reinsurance is compressing on-exchange premium spreads
- More Medicaid Expansion moves people who were buying plans and earning 100-138% FPL to Medicaid
- Maine and Virginia have hit their strides
- Mountain West expansions states are slowly starting up
- More off-ramps this year with wide spread marketing of short term limited duration plans, cost sharing ministries and association health plans
The biggest thing that could boost enrollment is if the Health Reimbursement Account scheme takes off quickly. I think that is more of a 2020 thing for plumbing reasons but I could be wrong.
I don’t expect to see much difference in enrollment due to outreach and advertising. We have baked into the baseline a very low level of advertising and assistance already, this is not new.
There is little to no policy uncertainty during the pricing cycle. There are no policy shocks. There is no free, earned media like in the Fall 2017. This is a business as new usual year.
Now let’s just go back to an earlier post on choosing insurance as that applies here as well:
- Insurance is complicated
… I know my limitations. I am very confident that I won’t make a horrendous choice. I am also very confident that I won’t make the optimal choice. And I’m okay with that. When I have to choose an insurance product, I engage in a strategy that minimizes my regret. I’m okay with sacrificing some perfection as long as I know that my eventual choice is at least good enough. The extra two or three or thirty hours of gaming out every potential scenario is not worth the time nor the stress.
- Identify what you value
How important is access to a particular set of doctors or hospitals? This will be a mixture of your health status and the learning/hassle costs of switching docs….
How much can you afford in a worse case scenario versus how much can you pay out each month? This is a tough trade-off. All else being equal, a higher monthly premium means more protection in a worse case scenario (that is less likely in the ACA as there are an increasing number of gold and silver plans with the same out of pocket maximum as bronze plans but merely take a lot more time/claims to get there). For a given monthly premium, what are you willing to concede to get a targeted level of protection? How important is a cap on exposure?
- Know where your help is
Insurance can be complex.
Most people don’t spend several thousand hours a year thinking about insurance markets. Some people do. Use those people.
Good luck, and ask for help in comments as needed.