If you don't have health insurance, Nov. 1 could be your lucky day

The percentage of Marylanders who lack health insurance is half of what it was before the Affordable Care Act, but that still leaves hundreds of thousands of people vulnerable if they are injured or become seriously ill. We would wager that most of them know how important health insurance is and want to have it but think they can’t afford it. That’s understandable given the news in recent years of skyrocketing rates, but the situation in Maryland has changed. If you don’t have insurance, you should check it out; it could be much more affordable than you think — and the more people who buy in, the cheaper it will be in the years ahead. Open enrollment starts Nov. 1 and runs through Dec. 15. Here’s what you need to know.

Rates are actually down.

Gov. Larry Hogan and the Democratic leaders of the General Assembly quietly worked together this year on a plan to stave off what had been expected to be catastrophic increases in the rates charged by the two insurers on Maryland’s Affordable Care Act exchange, CareFirst and Kaiser Permanente. It involved some real political risk, particularly for Mr. Hogan, since part of the plan could have been construed as a tax increase. (What happened is that the state agreed for one year to collect a health insurance premium tax that the federal government put on hold. Once the feds reinstate it, Maryland will drop it. We don’t consider that a tax increase, but in a political season, somebody could certainly have argued otherwise. It also required the Trump administration, which has made killing the ACA one of its top goals, to sign off.

But it worked. The reinsurance program Maryland established essentially covers the costs of some of the sickest and most expensive patients, leaving a healthier and cheaper risk pool for everyone else. As a result, rates will be lower by between 7.4 percent and 17 percent, depending on the plan. We’re not talking a slower rate of increase here. We’re talking rates that are actually lower than they are now. If you couldn’t afford it before, you might be able to now.

Real live humans can help you figure it out.

If you want a DIY approach, you can go to marylandhealthconnection.gov to shop for plans and enroll all on your own. There’s a moble app, too, if you want to use your phone. But health insurance gets complicated. If you have existing health conditions or established relationships with particular doctors — or if you are just having a hard time figuring out the difference between deductibles and copays and co-insurance — trained people in Maryland who can help you figure it out are just a phone call away. (The number is 855-642-8572.) In-person help is also available from a network of insurance brokers. You can find one close to you by searching here. The health benefit exchange will also hold a series of enrollment events around the state. A calendar is here. Our advice? Take advantage of the free help. There’s a lot more to consider than the sticker price of a plan, and a navigator can make finding the right one a lot easier.

The more people who sign up, the better.

The funding Maryland has secured is enough to pay for the reinsurance program for two years and partially for a third. The hope is that by holding down the rates initially, more people will join the pool — particularly younger and healthier ones — so that the costs of health care will be spread among more people, thus reducing the price of coverage. That would turn the current vicious cycle (in which increasing prices drive out all but the sick, thus making prices go even higher) into a virtuous one. More customers means more stable rates, and that could mean more companies competing for business and driving down costs. But it only works if people who may have thought they couldn’t afford insurance check it out.

Something to consider while voting.

There are more steps for our elected leaders to take. They could pass a law saying that any time the federal government suspends the insurance premium tax (it has happened more than once), Maryland will collect it and dedicate the funds to the reinsurance program. They could also respond to the federal government’s decision to eliminate the fine for those who don’t have insurance by instituting our own version of the individual mandate. Health care advocates have an innovative proposal that would allow those assessed the fine to use it as a down payment on insurance coverage. Both of those things would help lower premiums in the long run.

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