FEDERAL HEALTH INSURANCE EXCHANGE 2019 OPEN ENROLLMENT
The Federal Health Insurance Exchange (also known as the Marketplace) Open Enrollment Period runs from November 1, 2018 to December 15, 2018, for coverage starting on January 1, 2019. Similar to last year, the Centers for Medicare & Medicaid Services (CMS) is taking a strategic and cost-effective approach to inform individuals about Open Enrollment, deliver a smooth enrollment experience, and use consumer feedback to drive ongoing improvements across the Exchange platform. Consumers can visit HealthCare.gov and CuidadodeSalud.gov to preview 2019 plans and prices before Open Enrollment begins.
Key Updates and Enhancements to Healthcare.gov for the 2019 Open Enrollment
Streamlined Application Visual Refresh
CMS remains committed to improving the customer experience, this year the streamlined application on HealthCare.gov was refreshed based on feedback and testing. The refreshed application that will be available for some consumers will provide better content, improved help information integrated throughout the application, and enhanced mobile optimization. CMS will continue to make enhancements to the application based on feedback and testing.
Find Local Help Enhancements
The Find Local Help tool on HealthCare.gov has been redesigned this year based on feedback from consumers, agents and brokers. This year, consumers will be able to filter agents and brokers by their minimum years of participation on the Federal Exchanges. Additionally, for the first time, individuals will be able to search for a specific agent or broker by entering their first or last name. Find local help is a tool that allows consumers to search by city and state or ZIP code to see a list of local people and organizations who can help them enroll in coverage.
Improved plan information
CMS also added improved content on Health Savings Account (HSA) eligible high deductible health plans (HDHPs) to make it easier for consumers to search for and identify HSA-eligible HDHPs. In addition, HealthCare.gov now includes information on if a particular plan covers abortion services outside of exceptions for rape, incest, or if the pregnancy is determined to endanger the woman’s life.
Consumer Tools and Support
On October 26, 2018, CMS launched updates to window shopping (the “See plans & prices” page on HealthCare.gov) which allow consumers to preview 2019 plans and prices before Open Enrollment begins. As in previous years, window shopping lets consumers browse plans without logging in, creating an account, or filling out the official application. Starting November 1, consumers can log in to HealthCare.gov and CuidadodeSalud.gov or call 1-800-318-2596 to fill out an application and enroll in a 2019 Exchange health plan.
Consumer Call Center
The Call Center is often the front line of assistance for consumers as they apply for coverage and compare plan options. Last year, CMS’ Call Center staffing peaked at 10,000 people during Open Enrollment. CMS plans to have the same amount of staff this year. During last year’s Open Enrollment, consumer satisfaction rate was at an all-time high – averaging 90 percent – throughout the entire Open Enrollment Period. In order to help prepare the Call Center representatives to handle high consumer demand, CMS will continue providing extensive training to Call Center staff prior to Open Enrollment and weekly refreshers throughout the Open Enrollment Period.
In addition to the Call Center, in-person assistance will continue to be available to help consumers with enrollment. This includes local agents and brokers, Certified Application Counselors, and federally-funded Navigators.
Help on Demand
CMS will continue to offer the “Help On Demand” services for agents and brokers. This service allows consumers to choose to have an agent or broker in their area contact them directly for assistance while they’re available. For registered agents and brokers, this allows them to set times when they’re available and then reach out to consumers who expressed interest in needing help applying and enrolling.
For more information, visit: https://www.cms.gov/cciio/programs-and-initiatives/health-insurance-marketplaces/a-b-resources.html
Premium tax credits will be available in 2019 for individuals who qualify. Consumers can continue to use Exchange coverage and take advantage of its benefits, including premium tax credits. Plans available from insurance companies will continue to reflect reduced copayments, coinsurance, and deductibles for eligible consumers.
Quality Rating System (QRS) Star Ratings Pilot
CMS is conducting a third year of the QRS pilot program to test consumer reaction to the public display of health plan quality rating information during the 2019 Open Enrollment Period. The QRS Pilot Program displays quality ratings (or “star ratings”) for some health plans on HealthCare.gov. Each rated health plan has an overall quality rating of one to five stars, which accounts for member experience, medical care, and health plan administration.
CMS extended the QRS Star Ratings pilot this year to three additional states. In addition to Virginia and Wisconsin, the third pilot year will be conducted in Michigan, Montana and New Hampshire. The pilot testing helps CMS analyze the impact of QRS star ratings on consumer behavior, with the ultimate goal of providing consumers with the information they need to compare plans based on quality and pick a plan that best meets their needs.
For more information, visit: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/2018-QRS-QHP-Survey.pdf
Small Business Health Options Program (SHOP)
Similar to last year, for enrollment in SHOP Exchanges using the Federal platform, employers will be able to enroll directly with an issuer, or with a SHOP-registered agent or broker. HealthCare.gov provides information to help assist employers looking to enroll and SHOP-registered agents and brokers assisting consumers with SHOP coverage.
Similar to previous years, consumers who are currently enrolled in a plan will receive notices from the Marketplace prior to November 1 about the upcoming the Open Enrollment Period. These notices provide consumers with the dates for this year’s Open Enrollment and the importance of returning during this time to update their application and actively re-enroll in a plan for 2019, as well as customized messaging for their situation, such as if they’re at risk of losing tax credits. Consumers also receive notices from their current issuer with important information about premiums, coverage and benefit changes, and plan availability for 2019.
Consumers who are currently enrolled are encouraged to come back and update their information, shop, and pick a plan that best suits their health care needs before the December 15 deadline. Similar to Medicare’s Open Enrollment Period, consumers who miss the deadline to enroll in a plan of their choice will not be able to make any plan changes until the next coverage year unless they qualify for certain Special Enrollment Periods.
The majority of consumers whose plan isn’t available in 2019 will be automatically re-enrolled into a plan from a different issuer to avoid a gap in coverage – these consumers will need to pay their premium for January in order for this coverage to begin. Consumers whose issuer isn’t offering their plan in 2019 are eligible for a Special Enrollment Period due to losing coverage and have the opportunity to choose a different plan.
- Automatic Re-enrollment: As in previous years, CMS will automatically re-enroll consumers that don’t actively re-enroll by December 15 into their same or similar plan, and if that is not available, another plan with a different insurance company. The Marketplace will send a notice to those consumers that were automatically re-enrolled.
- Plans No Longer Available: Consumers whose 2018 issuer does not have a plan available to them for 2019 will receive a discontinuation notice from their current issuer by the start of Open Enrollment. Those consumers may also receive a letter from the Marketplace notifying them that they have been matched with an alternate plan from a different issuer to help avoid a gap in coverage. These consumers generally will need to pay their premium for January in order for their 2019 coverage to begin. Consumers are not under any obligation to stay with their new plan and are encouraged to take action and choose a plan by December 15.
To see examples of consumer notices, visit: https://marketplace.cms.gov/applications-and-forms/notices.html
Marketing and Outreach
Similar to last year, CMS plans to spend $10 million on marketing and outreach for the upcoming Open Enrollment Period. Last year’s Open Enrollment Period was the agency’s most cost effective and successful experience for HealthCare.gov consumers to date. CMS will continue to use similar marketing tactics from last year and focus funding and attention on the most strategic and efficient ways to reach consumers. This year’s outreach and education campaign will target people who are uninsured as well as those planning to reenroll in health plans, with a special focus on young and healthy consumers. CMS committed resources to proven high impact, low cost digital outreach efforts including short YouTube videos, social media, and mobile and search advertising.
CMS will also continue to use direct response methods including email, text messaging and autodial messages. Targeted email has proven to be the most cost efficient and effective way to reach consumers. As part of this effort, CMS will send most consumers emails throughout each week, with increasing frequency as the deadline approaches. CMS will also reinforce educational messaging through ongoing text messages and provide reminder calls encouraging consumers to take action before the December 15 deadline.
HealthCare.gov Scheduled Maintenance Windows
Every year, CMS establishes scheduled maintenance windows that provide periods of time when CMS and its partners can make updates or resolve issues. Maintenance will only occur within these windows when deemed necessary to provide consumers with a better shopping experience. Consumer access to HealthCare.gov may be limited or restricted when this maintenance is required. Regular scheduled maintenance will continue to be planned for the lowest-traffic time periods on HealthCare.gov, including Sunday mornings.
The purpose in scheduling these times is to minimize any consumer disruption. Like other IT systems, these scheduled maintenance windows are how CMS updates and improve our system to run optimally and are the normal course of business.
For more information on the scheduled and actual maintenance times, visit: https://marketplace.cms.gov/technical-assistance-resources/healthcaregov-maintenance-windows.pdf
HealthCare.gov Waiting Rooms
Similar to previous years, CMS may deploy a “waiting room” for some consumers who are logging in or creating an account on HealthCare.gov if website traffic becomes high enough to impact the consumer experience. The waiting room is one tool CMS utilizes to optimize a consumers’ experience because it allows CMS to control the volume of users on healthcare.gov resulting in better performance of the website. If they are in a waiting room, consumers will see a message asking them to stay on the page. The waiting room will refresh when a consumer can continue to apply and enroll with a smooth experience.
Weekly Enrollment Snapshots
Similar to previous years, CMS plans to release weekly enrollment snapshots throughout the Open Enrollment Period.
2019 Health Insurance Exchange Premium Landscape Issue Brief
The view the U.S. Department of Health and Human Services 2019 Health Insurance Exchange Premium Landscape Issue Brief, visit: https://aspe.hhs.gov/pdf-report/health-plan-choice-and-premiums-2019-federal-health-insurance-exchange
2019 Plan Landscape Data
For more information on 2019 individual and family health plans available in the Federal Health Insurance Exchange, visit: https://www.healthcare.gov/health-and-dental-plan-datasets-for-researchers-and-issuers/
2019 Health Insurance Exchange Public Use Files
To see the 2019 Health Insurance Exchange Public Use Files, visit: https://www.cms.gov/CCIIO/Resources/Data-Resources/marketplace-puf.html
2019 Rate Review Public Use File
To see the 2019 Rate Review Public Use File, visit: https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/2019-URR-PUF.zip
2019 Issuer Participation County Map
To see the 2019 Issuer Participation County Map, visit: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/Final-2019-County-Coverage-Map.pdf