BISMARCK, N.D. – As the 2019 Open Enrollment Period begins on Nov. 1 and ends Dec. 15, many North Dakotans must soon make critical decisions about their 2019 health insurance amid a barrage of news and opinions regarding healthcare. To help make the most informed decisions possible, the North Dakota Insurance Department encourages consumers to streamline their health insurance research process.
“Health insurance plans and coverage can change drastically from year to year,” Insurance Commissioner Jon Godfread said. “This is why it is so critical that as the Open Enrollment Period begins, North Dakotans thoroughly research coverage options to determine the best plan for themselves and their families.”
According to the U.S. Census and Kaiser Family Foundation, most North Dakotans accessed health insurance in one of three ways:
- Employer-sponsored Health Insurance – 55 percent participated in a group health insurance plan offered by their employer. This includes employees of large and small private companies, federal, state and local government employees, and active military.
- Public Health Care Programs – 29 percent received healthcare benefits through Medicare and Medicaid.
- Individually Purchased – 8 percent purchased health insurance on their own through the marketplace or an agent.
- Uninsured – 8 percent remained uninsured.
Within each method, there are important developments and information consumers should keep in mind as the Open Enrollment Period begins:
Employer-sponsored Health Insurance
- If already covered by an employer-sponsored plan, consumers should pay close attention to enrollment options this year. Premiums and coverage limits may have changed.
- If an individual has recently changed jobs or plans to change employment, they may be subject to a probationary period, up to 90 days, during which they are ineligible for group coverage.
- If coverage from a previous employer is lost, an individual typically has 60 days to enroll in private individual insurance on an exchange through a Special Enrollment Period.
- Consumers are encouraged to contact their employer with questions about their Health Savings Account or Flexible Spending Account, or if they have questions about enrolling in either.
Public Health Care Programs
- Medicare and Medicaid are government programs that help pay for health care. However, benefits, costs and eligibility requirements differ:
- Medicare is a federally funded program available to most U.S. citizens and permanent legal residents age 65 or older who have lived continuously in the country for at least five years. People younger than 65 may also be eligible for Medicare if they are disabled, suffer from kidney failure or ALS (Lou Gehrig's disease).
- In contrast, Medicaid is jointly funded by federal and state governments. Eligibility is means-based and the program has strict income requirements that vary from state to state.
- Open enrollment for Medicare Advantage and Medicare Prescription Drug coverage (Part D) takes place from Oct. 15 through Dec. 7, 2018. If an individual misses the deadline and did not experience a qualifying event, they can still apply during general enrollment (Jan. 1 through March 31 of each year), though they will have to pay a premium penalty.
- High-income earners (more than $133,500) may see increases in 2019 Medicare Part B premiums. Enrollees should contact Medicare for an estimate and plan accordingly.
- Medicaid enrollees should pay particular attention to possible changes to eligibility and coverage options.
Individually Purchased Health Insurance
- The 2019 Open Enrollment Period will run Nov. 1 through Dec. 15, 2018. Coverage begins Jan. 1, 2019. Consumers can begin researching their options at any time.
- Those who currently have coverage through the exchange and do not choose a plan for 2019 will be re-enrolled in the same or a similar plan. Consumers should take notice that this re-enrollment could result in higher costs to the consumer.
- Consumers can now enroll in the health care exchange marketplace through third-party insurers’ websites. The new direct enrollment option allows agents to handle the entire transaction. Consumers should compare plans before buying to understand all choices.
- Consumers who qualify for a subsidy should shop on HealthCare.gov. Those who do not qualify for a subsidy should consider contacting a licensed insurance agent to review all available options.
- There are two way to purchase individual insurance, either through the federally run health care exchange (healthcare.gov) or via a licensed insurance agent. A licensed insurance agent can help you with both methods, but if you qualify for an individual subsidy, you must purchase your insurance through the federally run health care exchange to receive a subsidy.
- A qualification calculator is available at www.healthcare.gov/lower-costs/qualifying-for-lower-costs/.
All three major North Dakota carriers are back fully operating statewide on the exchange (healthcare.gov) and off-exchange (through a licensed and appointed agent). The 2019 rates are outlined below:
|Carrier Information||2019 Rate Information|
|Company Name||Average Requested||Average on Exchange||Average off Exchange Only|
|Sanford Health Plan||23.8%||21.53%||7.60%|
|Medica Health Plan||29.2%||25.99%||23.03%|
|Small Group Market|
|Carrier Information||2019 Rate Information|
|Company||Average Rate Requested||Average Rate Approved|
|Medica Insurance Company||7.45%||4.82%|
|**United Health Care||--||--|
**United Health Care will be offering plans on the small group market starting in 2019, as this is their first year offering plans in North Dakota, there was no rate increase requested.
“It’s important to talk with a licensed insurance agent, regardless of your status on a subsidy. However, if you do not receive an individual subsidy, you need to be shopping with a licensed and appointed agent, and not on healthcare.gov. The rates between on-exchange plans (healthcare.gov) and those available through an agent are vastly different. The 2019 rates further illustrate the need for a comprehensive overhaul of the health insurance market at the federal level,” Godfread said. “Congress must work together to provide common sense reforms for this broken market.”
Approximately 84 percent of North Dakotans are covered by health insurance plans offered through employers that self-insure, participate in “grandfathered” plans purchased before March 2010 or receive benefits from government plans (such as Medicaid, Medicare, Tricare or federal employee plans). Today’s announcement will not affect the rates for these consumers.
The 2019 open enrollment period runs from Nov. 1, 2018 through Dec. 15, 2018. North Dakotans are encouraged to use this time to compare rates and sign up for new plans or renew existing plans during this period.
To help consumers choose the right coverage for themselves and their families, the Department recommends consumers:
- Start early. With more information gathered, smarter decisions can be made.
- Stay well-informed. The health insurance landscape is evolving rapidly. What is true today may be outdated tomorrow.
- Shop around. What made sense this year may not be the best solution next year, particularly if an employment situation has changed. Take time to shop around, and compare prices and plan benefits amongst different insurance companies.