FACT
SHEET
FOR
IMMEDIATE RELEASE
October 26, 2018
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
Window
Shopping
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.
Financial
Assistance
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.
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.
Re-enrollment Process
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.
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 Operations
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.
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.
Additional Resources
Weekly
Enrollment Snapshots Similar to previous years, CMS
plans to release weekly enrollment snapshots throughout the Open Enrollment
Period.
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