What to expect in Year 2 of ACA enrollment

The Affordable Care Act exchange, which begins its second open enrollment period this Saturday, will offer many Georgians lower prices this time around.

Bill Custer, a health insurance expert at Georgia State University, said Thursday that the average premium statewide for a 40-year-old nonsmoker for the second-lowest “silver” plan will rise by 2 percent from the 2014 figure.


But in some Georgia regions, the premium for that plan will drop by double-digit rates, he said.

Still, people looking for a second year of coverage in the exchange – or to get a policy for the first time – need to pay attention to many factors besides premiums. Deductibles, co-insurance, prescription drug coverage, and whether specific hospitals and physicians are in a network are among the major considerations.

One thing is almost certain: Healthcare.gov, the federal enrollment website, will work more smoothly during this enrollment period. Last year, the site was plagued with massive technical problems – so much so the federal government extended the open enrollment window.

The enrollment time frame is much shorter this time. The enrollment period extends to Feb. 15, but if people want coverage starting Jan. 1, they must sign up by Dec. 15.

More than 310,000 Georgians signed up for an exchange plan during the first enrollment period.

Regional differences

Georgia's regions in the insurance exchange
Georgia’s regions in the insurance exchange

The Georgia regions with big premium decreases, Custer said, include the Albany area of southwest Georgia, which will have a 23 percent drop for the second-lowest silver plan. Northwest Georgia will have a 19 percent decrease; and the Valdosta region will see a 12 percent dip, Custer said.

Such decreases are influenced in part by more competition from health plans in those areas, he said. (During this current year, southwest Georgia had the second-highest premiums in the nation.)

The Savannah region will have a 3 percent decrease for the second-lowest silver plan, but an area just south of it, in Brunswick, will see a 25 percent increase. The Columbus region will see a 2 percent increase, the Augusta region an 8 percent hike, while the Athens area will see a 4 percent drop and Macon will decrease 7 percent.

Here are tips for consumers to help guide them through the process:

Shop around

Consumers who enrolled this year in an exchange plan will be automatically enrolled in that same plan for 2015 if it’s still offered.

But don’t assume that this year’s plan will remain the best fit for you. The premiums and deductibles may have increased, and the physicians you prefer may no longer be in the health plan’s network.

“The best deal last year may not be the best for you this year,’’ Custer said. “Do a little shopping.”

With nine insurance companies participating this year in the health insurance marketplace in Georgia,  consumers should look at the various plan options available to them, said Cindy Zeldin of consumer group Georgians for a Healthy Future.

And costs other than monthly premiums should be examined closely. Deductibles tend to be higher for plans with lower premiums, so figure out what you’re most comfortable with, experts say. Co-pays and co-insurance costs also can make a big difference.

Update financial information

You should also update your income information to find out the correct tax credit or subsidy for the coming year. If your subsidy is too high, you’ll have to pay it back at tax time.

And you want to avoid getting a smaller subsidy than you’re eligible for because you’ll pay more each month for insurance than necessary.

Networks and medications

Confirm that your doctors and favorite hospital are covered by the insurance plan you’re considering.  Insurance networks change constantly, and insurers have increasingly “narrowed’’ their provider networks.

So you should call your physician’s office and hospital and make sure they are in the specific plan you’re considering.

If consumers have particular health needs or conditions, they may want to look particularly closely at the plan networks and drug formularies to ensure they enroll in a plan that meets their needs, Zeldin said.

Make sure the medications you take are on the health plan’s formulary.


In 2014, Obamacare’s first year, individuals are facing a penalty of $95 per person or 1 percent of their income – whichever is higher. The penalty will be taken out of their tax refund in early 2015.

But the penalty gets steeper this coming year. If you lack coverage in 2015, you’ll pay the higher of these two amounts: 2 percent of your yearly household income, or $325 per person for the year.

The 2 percent figure may end up being hundreds of dollars, Custer noted.

Don’t get double-billed

Healthcare.gov doesn’t have an automated process for letting insurers know when their members enroll in a different health plan. So if you decide to switch to a different plan, you should cancel your old plan to avoid being double-billed.

And keep the records of these changes.

Get help

Healthcare Cost

Open enrollment is a bewildering time for many consumers, whether they’re signing up for employer coverage, Medicare or the ACA exchanges.

Don’t hesitate to seek help if you need it.

You can consult a local insurance broker or agent.

Another place to go is healthcare.gov, which has a list of “navigators’’ or insurance counselors who can offer free help, as well as health clinics that can assist you.

“Consumers should know that in-person enrollment assistance is available at no cost to them if they want someone to help walk them through the process,’’ Zeldin said.

Seedco is supplying navigators for Georgia, and consumers and small business owners can call 1-855-899-6092 for assistance. Community Health Works is also providing navigators.

Or you can call the federal consumer assistance center at 800-318-2596.