Obamacare 2018: A guide for last-minute shoppers


Holly Johnson

Holly Johnson

Blog author Holly Johnson

Published December 3, 2017|5 min read

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There's less than two weeks left to purchase health insurance through the federal marketplaces created by former President Barack Obama's health care law. Healthcare.gov closes on Dec. 15, 2017.

Translation: If you're uninsured or under a plan set to expire and don’t act now, you won’t have coverage for 2018 unless you qualify for a special enrollment period.

Buying health insurance is daunting, under the best circumstances. (So. many. numbers.) Still, even under a time constraint, you can get it done. Here’s a guide for last-minute 'Obamacare' shoppers.

1. Gather everything you need to apply

Before you apply for health insurance on the exchanges, you’ll need some basic information about your household and income. That includes Social Security numbers, your latest tax return, your address and more. This marketplace application checklist lets you know everything you need to get started.

2. Hop on (the right) exchange

Most states use the federal marketplace Healthcare.gov, but 11 run their own exchanges. If you live in one of these states (California, Colorado, Connecticut, Idaho, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont and Washington) or the District of Columbia, you’ll have to shop on its exchange. Incidentally, a few of these exchanges are open longer than the federal marketplace, so, depending on where you live, you might have more time to shop. We’ve got a state-by-state guide to 2018 open enrollment here.

Once you’re on the right site, follow the prompts and enter all information to the best of your ability. Share your family size, anticipated 2018 income, address and more to move on to the next step. If you just want to browse plans before entering private information like your family’s Social Security numbers, you can do that, too.

3. Find out if you qualify for subsidies

Under the health care law, people who earn between 100% and 400% of the federal poverty level are eligible for a premium tax credit when they purchase a plan through the exchange.

In 2017, that cutoff worked out to $48,240 for an individual, $64,960 for a couple and $98,400 for a family of four. (Numbers for 2018 won't come out until January, so these are the numbers used for estimates when signing up this year.) If you earn less than those amounts, the tax credit (available in advance) can lower your premiums. You might also qualify for cost-sharing subsidies that help you save on out-of-pocket costs.

The best way to find out if you’re eligible for aid is to enter your information on the federal or your state exchange.

4. Think bronze, silver, gold or platinum

Obamacare coverage comes in four tiers — bronze, silver, gold and platinum. Bronze plans come with higher deductibles and lower monthly premiums. Gold and platinum plans come with higher monthly premiums, but lower out-of-pocket costs.

Silver plans, the most popular form of coverage, tend to fall somewhere in the middle in terms of premiums, copays and deductibles. But it’s extra-important to spend time digging into your options this year, since the marketplaces are … well, a real mixed bag.

Why? It’s complicated, but, thanks largely to steps the Trump administration, some people who qualify for subsidies are finding bronze plans for $0. And people who don’t get subsidies could find gold plans that are more affordable than silver plans. That’s why you’ll want to …

5. Carefully compare plan details

It helps to look at plans in terms of their total costs. The big ones include:

  1. Your monthly premium: the amount of money you’ll fork over every month just to have the plan

  2. Your deductible: the amount of money you have to put toward bills before your insurance kicks in

  3. Your copay: flat fees you pay for services like appointments or prescriptions

  4. Your coinsurance: a percentage of the cost you pay for health services, usually after you’ve met your deductible

Policygenius can help you easily shop for and compare on-exchange and off-exchange health insurance plans across these costs. And, yes, if you don’t qualify for federal subsidies, looking into off-exchange plans is worth a whirl. These policies have to offer the ten essential health benefits without having to adhere to more stringent marketplace guidelines, so they’re often cheaper. We’ve got more on off-exchange plans here.

6. Consider your health … & risk tolerance

While not a perfect system, given illness and injury can happen to anyone at anytime, it helps to take your health into account when you decide which level of coverage to go with. If you are healthy and don’t anticipate having a lot of medical bills, a bronze plan with lower levels of coverage may be sufficient. (Note: Opening an Health Savings Account will help with pre-deductible costs.) If you have a medical condition or always meets your deductible, paying higher monthly premiums for a gold or platinum plan may lead to more predictable health care costs throughout the year.

7. Check & compare networks

Before you pick a plan, make sure to check networks to see if your doctors are covered. The last thing you need is a new policy that doesn’t let you see your primary physician and/or specialists, right?

On Healthcare.gov, checking is easy. Simply click on a plan you’re considering then on the button that says “see if providers & drugs are covered.” From there, you can type in the names of your doctors, specialists and medications to see if they’re in the new network.

8. Sign up

Open enrollment ends on Dec. 15, 2017 for coverage that begins on Jan. 1, 2018. To get covered, you need to enroll in a plan before the Dec. 15th or your state's deadline and pay your first monthly premium in time.

If you don’t buy coverage before the deadline, you will have to wait until next year or until you have a life event that qualifies for a special enrollment period. These periods kick in when you have a change in household, move, lose your health insurance or meet other criteria.

9. Can't find a plan? Consider other options

Like we said, the marketplaces are a mixed bag. While some people (generally those who qualify for subsidies) are finding plans cheaper than their plan last year, other Americans are encountering limited options and sky-high premiums. If you fall into the second bucket, you have a few options. Again, it's good to look into an off-exchange plan. There are also health care sharing ministries, short-term health insurance, limited benefit plans or prescription discount cards. These options have their drawbacks, but they're generally better than going entirely without coverage. You can learn more about health insurance alternatives here.

*Image: Michael Blann**