‘Tis the season for Open Enrollment: What you need to know to navigate the system

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Click the link above to watch the full interview on NH PBS’s The State We’re In.

Open Enrollment

‘Tis the season for a lot of things. One of the most important for you and your family may be health insurance. It’s open enrollment time for those seeking plans through the federal government. Host Melanie Plenda is joined by New Hampshire Bulletin Senior Reporter Annmarie Timmins and Insurance Department Deputy Commissioner D.J. Bettencourt to talk about open enrollment and help us navigate some of the system’s complexities.

This content has been edited for length and clarity. Watch the full interview on NH PBS’s The State We’re In.

Melanie Plenda: Commissioner, let’s start with you. Can you give us some background for viewers who may not be familiar with the system? What is open enrollment? What does it mean, and what’s the significance of it?

D.J. Bettencourt: The fall and the early part of the winter is not just about pumpkin spice, cool weather, and the holidays. It is open enrollment time, which runs from November 1st of this year until January 15th, 2023. I admit that I’m unusual; I find insurance to be very interesting, so this is an exciting time of the year for me and the rest of us here at the insurance department. Open enrollment is the opportunity for anyone, including those who don’t have or prefer not to have health coverage through their employer or aren’t getting coverage through a government sponsored plan such as Medicaid or Medicare, to purchase health insurance coverage in New Hampshire. We have our residents use the federal marketplace or exchange, which can be found on healthcare.gov, and they can go to that website to review the opportunities and plans that are available.

We have three health insurance carriers on our individual market. They are Anthem, Harvard-Pilgrim, and Ambetter. If you miss that window of open enrollment, you’re not entirely out of luck, but you will have to experience a qualifying life event to get a special enrollment opportunity. Those are things like getting married, a job change, moving into or out of New Hampshire, or having a baby. You’ll have 60 days after one of those events to change your plan or to get coverage if you miss the open enrollment window.

Melanie Plenda: Annmarie, you recently wrote about the fix of the so-called family glitch. Can you explain what that is and what was fixed?

Annmarie Timmins: The family glitch historically, if your spouse was covered under an employee plan at their workplace, and the individual plan didn’t qualify for a subsidy, you wouldn’t be eligible even if your spouse took the family plan, which is more expensive and covers more people. Even if that cost would qualify for the subsidy, you wouldn’t have the option of saying, as a family plan person, I’m gonna use the marketplace because it would be cheaper for me. That’s the family glitch, and that has been eliminated. Now if say, my spouse had a plan that didn’t qualify for just himself, but if we did the family plan and it would qualify, I could go over and instead use the marketplace and take advantage of subsidies.

The State We're In - NHPBS
The State We’re In host Melanie Plenda with guests for this episode, NH Insurance Department Deputy Commissioner D.J. Bettencourt, and NH Bulletin Senior Reporter Annmarie Timmins.

Melanie Plenda: There are two other significant changes to subsidized federal health plans. Annmarie, can you explain what those are?

Annmarie Timmins: One is that the income cap has been lifted. Under the old plan, there was an income cap. If you reached it, you were no longer eligible for a subsidy, even if you went over by a dollar. It was called the cliff; your benefits would end, your subsidy would end. Now it is more of a taper. If you start creeping up or go over an eligibility limit, you would see your subsidy go down slowly. As your income increases, you’re not going to get to a point where suddenly you don’t have any subsidy. I think that’s been a big change I’ve heard the navigators talk about quite a bit. The second one is just enhanced subsidies, so people are receiving more subsidies than they would have previously. I think navigators are really trying to get that message out as well because it’s really more affordable than it has been previously.

Melanie Plenda: Commissioner, what advice do you have for residents navigating the system for the first time in researching plans?

D.J. Bettencourt: There are some basic good hygiene practices when you’re purchasing any sort of insurance product. The first is to read the policy. That seems pretty obvious, but you wouldn’t believe the number of calls that the department receives from citizens who have an insurance policy, have had it for many years, have paid the premiums on it, but have never read it, and then a crisis arises. They’re in a panic and they don’t understand what to do. Reading that policy in advance is always a good first step. You might have had a plan in the past and are happy with it but it’s critical to make sure that the plan hasn’t changed, and if it has changed what that impact will be on you. Other critical considerations are obviously things like coverage, use, copays, and deductibles.

Some of that is obviously financially driven, but people need to consider their lifestyles when making a choice. Look at your receipts from the previous year. Have you been healthy? Do you only go to the doctor for that yearly physical and maybe perhaps when you get a sore throat in the winter time? If so, then maybe you want to go with a plan with a higher deductible and co-pay, but a lower monthly premium because you don’t go to the doctor that often. But if you’re like me with a wife and three children under the age of 10, then you probably want to consider a higher monthly premium but lower deductibles and copays, because I’m there all the time with my kids with the runny noses and the stomach bugs and the bumps on the head that require the ER visit. Understanding your personal situation and your family’s needs and taking it from there is always my advice.

Melanie Plenda: Annmarie, let’s talk about those navigators. In your story you spoke to free navigators, can you explain who they are and how they can help?

Annmarie Timmins: I just can’t emphasize enough how much they can help. There’s two companies, Health Market Connect and First Choice Services. These are federally funded programs, and they are here just to help you sort through all of this information. If you read your policy and you still have questions or you just want a second opinion, they can help you. There’s no charge for their services. Both of these groups have people in the state if you want to meet face to face and also phone service. They’ll communicate with you by Facebook Messenger or text. It’s available in multiple languages, so it’s really accessible. They won’t pick a plan for you, but they will help you think about those things the deputy commissioner mentioned which is, I’m at the doctor this often, or this is the premium I can afford now. It’s been amazing to me to see them work with folks, and they really recommend to see them sooner rather than later for a couple reasons. If you don’t look at the plan you have this year and make a decision by December 15th about whether you want to change, you will get that same plan next year. It’s important to look at what your plan is now and whether that suits you going forward. 

The other concern is that during the public health emergency, which right now is supposed to end at the end of January, people who were qualified for Medicaid who maybe no longer do because their income levels have changed, they’ve remained on Medicaid. When that public health emergency ends, they will no longer qualify and they may find they don’t qualify for Medicaid anymore and didn’t get on the marketplace when they needed to. While there’ll be some chances later after that public health emergency ends, it’s harder. There may be lots of people who’ve waited so you may be in a long line and have a hard time getting through. Act sooner rather than later. That health emergency is to end in late January, which is not too long. It may be extended to April, but we don’t know that yet. It is really important to reach out to a navigator, the insurance department, for questions on how to proceed and what choices to make. 

Melanie Plenda: It sounds like that impacts 90,000 Granite Staters. Can we talk a little bit more about that? What’s going to happen when the federal public health emergency ends?

Annmarie Timmins: There are about 90,000 people in New Hampshire who are on Medicaid. A lot of people, for reasons that are obvious, had to go on to assistance during the pandemic. They lost jobs or couldn’t go to work because of childcare shortages, and states were not allowed to do what’s called a redetermination during the public health emergency, which means if you are on it, you are on it still unless you decide to take yourself off of it. Right now, the state is doing these redeterminations and trying to reach people to say, you need to do this. It was 90,000 in June or July, I checked in with the department. I think that’s down by 20,000 people or so, but that still leaves a lot of people who may find themselves suddenly without coverage when this public health emergency ends.

Melanie Plenda: Commissioner, what advice do you have for residents who may find themselves in that situation, and how is the state reaching out to them?

D.J. Bettencourt: The first is to the greatest extent possible for Granite Staters to take some personal responsibility in initiative to see if they are still eligible for Medicaid. Don’t procrastinate or wait until the last minute because as Annmarie said, if you have this rush to the door, you’re going to clog the system and be in a longer line than you would be if you took initiative upfront. There are plenty of resources available to help people understand their status. Our colleagues over at the Department of Health and Human Services are there to help folks, so people should take advantage of those opportunities when the public health emergency ends and redetermination begins again. 

Individuals will have the ability to purchase a product on the individual market outside of the current open enrollment, but why not be proactive and take advantage of getting coverage now? For those who are currently on Medicaid because they lost their job during the pandemic, if they are back at work and are getting coverage through an employer-sponsored plan, or maybe if those individuals went onto the individual market, then let the state know so that we don’t provide them with Medicaid coverage that they don’t need anymore. We don’t want people to have unnecessary duplicative coverage. In terms of outreach, the state is really going all out. We have sent multiple notices, letters, phone calls, text messages community events, and I’ve even heard a rumor we’re using carrier pigeons; you name it, we’re using it. We really are working hard to get the word out to folks so that they understand what this process involves, what it means for them, and where they can go to get coverage if they are impacted.

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