People can start buying insurance on the Affordable Care Act (ACA) marketplace, otherwise referred to as Obamacare or the Federal Health Insurance Exchange, on Wednesday. Last year, 12.2 million people signed up for an ACA health plan through healthcare.gov or their state’s own health website. Given the dysfunction coming from Washington, D.C., consumer activists are concerned that not as many people will sign up for coverage this year. (Pro-ACA groups have projected anywhere between 1 to 3 million fewer people will enroll.)

This is a big problem. Even though the ACA led to big gains in health insurance coverage, 8.8 percent of the population, or 28.1 million people, is still uninsured, according to findings by the U.S. Census Bureau. A large amount of the uninsured are eligible for subsidized Marketplace coverage or Medicaid, insurance for people with modest income. Health activists are trying to get this population covered, while simultaneously looking to keep people enrolled and maintain the country’s record-low uninsured rate. The uninsured rate has already increased amid the uncertainty coming out of Washington.

This open enrollment period, things will be a little different. Nearly every health expert has found that the change in premium prices this year can largely be attributed to the current administration’s actions on health care. About 2 million people who rely on the ACA for their health insurance and receive no federal assistance will see premium increases that range between 17 to 35 percent for the lowest-cost plans. Additionally, people in eight states, or 29 percent of enrollees, will have only one insurance company option — a nine percent increase from last year. More competition tends to drive costs down. Robust insurer options has always been challenging, even under the Obama administration.

But overall, things aren’t as bad as they could be. And despite President Donald Trump’s intentions, Obamacare isn’t dead. People, who do receive federal assistance for their health insurance, should know that if they take the time to shop, most could purchase a plan similarly priced to last year’s or — in some cases — even cheaper (despite the president’s intentions). The Department of Health and Human Services (HHS) and Kaiser Family Foundation (KFF) released reports Monday on how the marketplace fares this year, and it doesn’t bode bad for all consumers. In fact, 80 percent of plans offered on healthcare.gov are $75 or less, just nine percent more than last year, according to HHS.

Here’s what consumers who rely on the ACA for health insurance need to know this open enrollment season:

Open enrollment outlook

For consumers who buy plans on the Marketplace, shopping will likely look different than last year’s enrollment period. First off, open enrollment is shorter this year for people who buy plans on healthcare.gov — a decision reportedly made by the Obama administration. People can only buy plans between November 1st and December 15th; people in a handful of states with their own site can shop around for a little longer.

The Trump administration is making it harder for people to enroll in the ACA in a number of ways:

Shutting down the healthcare.gov website for 12 hours nearly every Sunday

Cutting funding by 40 percent to navigator groups that help people enroll for coverage. (Cuts have shut down or scaled back a handful of navigator groups nationwide.)

Slashing the advertisement and promotion budget by 90 percent. (Now, most enrollees don’t know about key open enrollment dates.)

Made premium subsidies less generous at first. (The administration put in place a new rule that tethered the subsidy to a less generous plan.)

This is a pretty bleak description of open enrollment, but it’s not all that way.

For example, a returning ACA customer in Palm Beach County, Florida received some good healthcare.gov news Saturday. Greg Jenkins, a navigator for the Epilepsy Foundation based in Florida, told the ACA customer — who’ll go nameless for privacy concerns — that her Florida Blue plan premium is just a dollar more expensive than last year’s.


“She was elated,” Jenkins told ThinkProgress. She was under the impression premiums were skyrocketing. Fortunately for her, she receives subsidized care. She’s looking at a plan that’ll cost a $1 per doctor visit, $2 for generic drugs, and no deductible. She’s looking to re-enroll in her silver plan come November 1st, Jenkins said.

You better shop around

To get a good deal, consumers are advised to shop around. This is true for most shopping experiences, but it is especially crucial (and harder) for people looking to buy plans on the Marketplace this year. Last open enrollment period, nearly 3 million people automatically re-enrolled in their health plan. This year, these people — and others tempted to do the same — are being told to browse around first.

There are four different metal plans on the ACA that vary according to how much the insurer covers: bronze, silver, gold, and platinum. Premiums for 2018 are significantly rising in most U.S. counties, in part due to the Trump administration’s decision to end key subsidy payment to insurers. But it’s also true that as premiums go up so do premium tax credits, a federal subsidy tethered to the lowest-cost silver plan.

Many states loaded rate hikes to the lowest-cost silver plan and so now the premium tax credit are especially generous. According to HHS, the average tax credit will increase by an estimated 45 percent from 2017. A majority, or 83 percent, of current ACA enrollees qualify for these tax credits.


For the other 17 percent of ACA enrollees, there’s really no way around pricey plans. Or as Jenkins put it they are “out of luck.” Get America Covered’s co-founder and former HHS official Joshua Peck’s only recommendation for those with no subsidies was to shop.

“For people who have marketplace coverage, subsidies or not, return to healthcare.gov,” he said in a press call on Monday. “Look at options an plans available — every year benefits and prices change.”

Take advantage of all options

“If there is some upside to a silver plan growing from a consumer perspective — and if you have subsidized care — it’s [that] you can get a good rate on a bronze or gold plan,” Chris Sloan, senior manager of the health industry consulting firm Avalere, told ThinkProgress. According to Avalere, premiums for silver plans on the exchange increased 34 percent on average.

While consumers tend to gravitate more toward purchasing silver plans — because they fall roughly in the middle in terms of coverage and cost — gold and bronze plans are a viable and sometimes cheaper option.

In fact, there are hundreds of counties nationwide where premium tax credits cover the full premium for the lowest-cost bronze plan, according to KFF, effectively leaving some consumers with zero monthly insurance costs. It’s quite the sell upfront, but only if consumers don’t mind high out-of-pocket costs once they need care. Bronze plan deductibles can be very high, meaning people with this plan need to pay thousands of dollars before the insurer starts to pay its share.


“If it’s well publicized, it could be a good idea for the young invisibles, if they are low-income,” said Sloan. Whether this happens, who knows, he said.

Islara Souto, the statewide navigation project director for Epilepsy Foundation in Florida, couldn’t recall a time she personally enrolled anyone in a bronze plan. Her navigator program covers 35 counties and enrolled nearly 3,000 people last year in either the Marketplace or Medicaid.

“They want to use their insurance; they don’t want it to collect dust,” Souto said referring to the high deductible that deters her costumers from buying bronze plans.

Souto told ThinkProgress that a lot of her customers are interested in coming and perusing their options. She has scheduled seven appointments last week after speaking with 15 current enrollees. She hopes they will take advantage of all options available.

CORRECTION: An earlier version said there was a two percentage change in the number of enrollees with just one insurer; it has been updated to reflect there was a nine percent change.