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Open enrollment is here. Now what?

Karen Shakerdge

You may have heard a few different numbers regarding insurance costs rising for 2017. Not all states have the same rate increases. In New York, plans are going up an average of 17 percent.

Not sure what these changes in premium costs mean for you? Or what you need to do if you're already on a health plan through the exchange? Wondering if you need to bother with the exchange if you get health insurance through your employer? 

WXXI's Karen Shakerdge sat down with Lisa Ball, staff attorney at Legal Assistance of Western New York, specializing in health, to learn more.

Shakerdge: For folks that are already enrolled, what changes can they expect come this open enrollment period?

Ball: One thing you're going to see is that there are premium increases unfortunately but the flip side of that is as premiums increase the advanced premium tax credits also increase. And that's because the advanced premium tax credits are based on the cost of the health plans.

Shakerdge: If I got my health insurance through the exchange last open enrollment - and I don't do anything - what happens? Do I just get by default into the same plan? How does that work?

Ball: So if you check the option that said you would let them auto renew you, so, you have the option to do an auto renewal. Some people don't feel comfortable with that - if they work seasonal work or they're freelancing or they run a small business that might not be the best option - but if you are doing the same thing year after year what they can do is check the IRS records. And make a notice. And they'll say we're going to auto enroll you into this plan, you need to pick a plan, so sometimes you don't need to do anything. If you need to renew this year for the Qualified Health Plan, please go into the website, starting on the 13th and ending on the 31st [of January]. You do not want to be kicked out of your Qualified Health Plan because you failed to enroll during open enrollment. There are no special enrollment periods if you fail to do what you need to do. So it's very important that you take care of your renewal by January 31st.

Shakerdge: Just to go back for a second to the premiums going up - so they're going up on average about 17 percent in New York state - what does that actually mean on the ground? Does that mean I'm going to be paying 17 percent more for my health plan and how do the subsidies work into that?

Credit Karen Shakerdge / WXXI News
Lisa Ball, Staff Attorney at Legal Assistance of Western New York.

Ball: So the average cost, with tax credits, for consumers is probably going to be an increase between six and nine percent. Which isn't nothing. It's not something to sneeze at and it's okay to be concerned about those things. I will say though, that, on average New York state is well below - is on par or below other premium costs for the rest of the country. Also, one thing to keep in mind is that, the advanced premium tax credits take away some of your fiscal responsibility to pay premiums whereas when you're looking at employer sponsored health insurance costs -- your employer sometimes can push off the full rate increase onto the employee. So it may actually still be cheaper to buy insurance through the marketplace than it is to get health insurance through your employer. So just because you're insured through your employer, I would say take a look on the marketplace, you can do an anonymous estimate.

Shakerdge: And that six to nine percent increase, is that really pegged to any particular plan?

Ball: The higher your income is the more substantial that amount is going to be because of how the subsidies work. So the lower income you are, the less that you're expected to pay out of your available income for health insurance coverage. The one nice thing is that there's transparency now, right. Before we were just saying 'health insurance costs were going up,' no one was really talking about it. Now we know why it goes up. They can pinpoint the data. And so some of the reasons why rates have gone up is because the cost of prescription drug coverage has increased substantially. The cost of inpatient and hospitals stays has gone up and so there's some hard data now, which is actually a really positive benefit. Because we can really see as a country where we maybe need to make some other systemic changes to really lower the cost of health insurance coverage in this country.

NY State of Health, commonly referred to as the marketplace or health exchange, has an online directory of navigators if you are seeking assistance with enrollment (free of charge).

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