Although open enrollment under the Affordable Care Act ends Jan. 31, the enrollment period has already seen a plethora of both recurring and first-time issues.
For multiple years, HHS has been partnering with pharmacies to help individuals sign up for coverage — and this year was no different. On the other hand, a number of rare and unforeseen issues have occurred. For example, the deadline for coverage beginning Jan. 1 was pushed back two days due to "unprecedented demand." PPOs have been fading from the ACA exchanges this year, and multiple health insurance company CEOs have openly discussed their qualms about staying on the exchange. Regardless, three trends and issues have emerged and been of particular importance during this year's open enrollment period.
Premium increases
In October, information was released on the increase in premium prices across the nation, especially among large insurers. Although the rate of increase varies from insurer to insurer, many of the premium rises can be chalked up to evaluating risk.
"If [the increases] were significant, either the insurer pool may have changed, or even if it did not change, maybe insurers are taking a look at risk, and increasing that to be more in line with the cost of care for participants," says Amy Gordon, partner at Chicago-based McDermott Will & Emery. In an attempt to limit high-cost care, many of the insurers then created more narrow networks of providers.
However, premium rates haven't increased in every state. "For some states, premiums actually went down," says Ms. Gordon. According to a Kaiser Family Foundation study, rates in Connecticut decreased by approximately 1 percent. "Insurers may have overestimated what the risk was going to be last year," Ms. Gordon added.
Cost comparison among consumers
The premium raises have caused consumers to more closely evaluate their options for 2016 health plans.
According to Ms. Gordon, the majority of individuals assess the deductible and out-of-pocket cost of plans on the market. Next, they check the provider list. Since many individuals hope to continue seeing their current provider, they want to ensure they'll be able to do so. Conveniently, HealthCare.gov has made cost assessment relatively simple — the website upgraded its platform to allow consumers to compare costs of different plans.
After evaluating the various plans on the marketplace, some individuals choose low-cost plans. Not only consumers with lower levels of income opt for low-cost plans; other demographics go with these plans, too. "Many young, healthy people will choose [low-cost plans] because they believe they will have very few if any claims in the next year," says Ms. Gordon.
Enrollment trends among young adults
For these young, healthy people, having a low-cost plan could be a problem if an emergency occurs and their claims spike. But going without insurance could be even more costly due to the ACA's individual mandate penalty. In the past, the cost of the penalty was not high enough to sway consumers to get coverage. "The penalty to individuals was so low, many people looked at their finances and said it's best to pay that individual penalty," says Ms. Gordon. But for 2016, the average individual mandate penalty is expected to increase 47 percent, according to a Kaiser Family Foundation study.
Nevertheless, many young people still remain uninsured. "Many young adults have that invincible mindset and elect to go without insurance," says Ms. Gordon.
Both the ACA and individual insurers are taking action to prevent young adults from staying uninsured. Under the ACA, children under the age of 26 can be added to their parents' health plans, which mitigated the number of uninsured young adults. Insurers are also targeting the young demographic. "Many insurers are looking at ways to be more attractive to healthier populations," says Ms. Gordon. "I can see them adding benefits or offerings that would make their coverage more attractive to that group than to somebody who chooses not to live a healthy lifestyle."
More recurring and first-time issues could occur in the few short weeks that remain of this year's ACA open enrollment period. Regardless, these three issues — premium increases, cost comparison and enrollment trends among young adults — will play a key role in how consumers, insurers and providers fare in the marketplace.
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