Today is a very big day in the health care world: around 1:30 a.m. this morning, Obamacare's health insurance marketplaces went live for round two of open enrollment. This is the start of a three-month long sign-up period, where people who bought Obamacare last year can renew their plans — and others who are still uninsured have another shot at getting covered.
This year, open enrollment's start has (so far, in the eight or so hours we know about) gone more smoothly than last year, when Healthcare.gov barely functioned at launch. There are no reports of massive glitches or the website stalling out. But there are still big challenges that the Obama administration faces as it heads into round two of sign ups.
1) What is open enrollment?
Open enrollment is a relatively short, three-month window for purchasing health coverage. And it exists to ensure that people buy insurance coverage not just when they're sick, but when they're healthy, too.
The Affordable Care Act doesn't let people buy coverage year-round. If it it did, you could imagine people signing up — in the most extreme examples — in the ambulance on the way to the hospital. This would make premiums skyrocket, as people would buy coverage at the exact point when they were expecting incredibly high medical bills.
To prevent that, Obamacare (and most plans you get at work, too) says you have to sign up in a certain time frame, and commit to buying coverage all year long. For Obamacare, that time frame is November 15 through February 15. There are exceptions to this rule. If you have a new baby, you're allowed to have a special enrollment period; there's no way said baby could have signed up before it was born. There are a handful of other exceptions, too, all listed here.
2) Last year's Healthcare.gov launch was a disaster. Will this one go better?
It was nearly impossible to shop for health insurance on Healthcare.gov during the first day of open enrollment last year. Only six people managed to enroll on October 1, 2013, and it really took until December for the website to function normally.
Most reports of those shopping on Healthcare.gov this morning are anecdotal, but they do tend to be positive. Last year, on day one, there were absolutely no tweets like this.
well done http://t.co/827cbN4kol I have applied and accepted my plan in exactly 25 minutes this year!!— Linda W (@lindaw) November 15, 2014
The team behind Healthcare.gov has put a decent amount of work into fixing the website over the past year. It brought on a new chief executive (Kevin Counihan, who helped Connecticut launch one of the country's best-run exchanges in 2014), significantly shortened the application process, and created a window shopping option. The lack of a place where consumers could browse in 2014 was blamed for creating a bottleneck as a crush of shoppers tried to fill out applications.
This isn't to say that there won't be problems. But, most of what we know now suggests thing will go better this year than last — and the bar for meeting that target is very, very low.
3) How do I sign up during open enrollment?
This is the easiest question to answer:
- Go to Healthcare.gov (and if this isn't where you buy insurance, because your state runs a marketplace, Healthcare.gov will tell you that when you enter a zipcode)
- Fill out an application
- Pick a plan (and if you're confused about the terms, then check out this guide to confusing health insurance jargon)
- Pay a first month's premium for said plan
4) Well what do I do now?
You control your own destiny, but you might enjoy watching this video of Otter Pup 681 failing adorably at trying to control a tiny basketball.
5) How expensive is Obamacare this year?
Premiums on Healthcare.gov will increase slightly in 2015 — but vary a lot depending on where you live.
A new analysis from health research firm Avalere Health showed that, on average, premiums for bronze plans (the skimpiest products) will go up by 4 percent next year. Silver plans (which offer middle-of-the-road coverage) will have a 3 percent premium increase.
But those averages mask huge variation. Average silver premiums are falling by 18 percent in New Hampshire — but increasing 28 percent in Alaska. There are two states where average premiums are going up by more than 10 percent (Alaska and Florida) and two where they're dropping by double digits (Mississippi and New Hampshire).
And even these state figures likely mask a lot of local variation, with premium changes likely varying from city to city.
In terms of how much Obamacare actually costs, that depends on where you live and how old you are. But as a benchmark, Avalere did calculate the average silver plan premiums for a 40-year-old man. In the states that use Healthcare.gov, they range from a high of $683 in Alaska to a low of $280 in Kansas.
If you want to get a sense of what your premium would cost, you can use this premium estimator tool from Healthcare.gov.
6) How many people will sign up during open enrollment?
Nobody knows for sure, but the Obama administration has been tamping down on expectations over the past week.
Health and Human Services Secretary Sylvia Burwell said Tuesday that the White House has a goal of signing 9.1 million people up for exchange coverage in 2015. That would be about 2 million more than those currently enrolled — but also about 30 percent less than what the Congressional Budget Office expects. It has forecasted that 13 million people will enroll through the marketplaces this year.
It's difficult to predict how many people will sign up this year, in part because we've had so few insurance expansions in the past. That makes it difficult to know how quickly these expansions grow. There are mostly two — the Children's Health Insurance Program and Medicare Part D — that forecasters look at to make projections. But aside from that, it's a bit of a guessing game.
I've also included in the chart above a projection from Charles Gaba, the whiz behind ACASignUps.Net who has done some of the most impressive forecasting data on the health care law. He estimates that 12 million people will enroll in plans and 10.6 million will ultimately pay. His forecasts have been incredibly accurate in the past, so they're definitely ones to pay attention to.
Correction: an initial version of this article misstated the state where premiums are dropping by double-digits. It is Mississippi.