The Federal Health Insurance Exchange (also known as the Marketplace or Affordable Care Act) Open Enrollment Period runs from November 1, 2019 to December 15, 2019, for coverage starting on January 1, 2020. Similar to previous years, 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 2020 plans and prices before Open Enrollment begins and for the first time HealthCare.gov will also display quality rating information in states that use HealthCare.gov, expanding the information available for consumers in their decision-making when comparing health coverage choices.
NEW THIS YEAR
Key Updates and Enhancements to Healthcare.gov for the 2020 Open Enrollment
Quality Rating Information Displayed in HealthCare.gov States
Quality ratings will be displayed on HealthCare.gov when consumers view the list of plans available in their area in HealthCare.gov states this year. Under the five-star Quality Rating System, Exchange health plans are given an overall rating on a 1 to 5 scale, with 5 stars representing highest quality. The overall star rating is based on three categories: Medical Care, Member Experience and Plan Administration. In some cases — such as when plans are new to the Exchange or have low enrollment — ratings may not be available.
Star ratings in the Exchange help make it easy for consumers to compare health coverage choices by giving consumers a snapshot of how each health plan’s quality compares to that of other Exchange plans in each state in a given year. A quality rating of 3 or above means that a health plan is considered average or above average as compared to other plans across the country. For the 2020 coverage year, 80 percent of plans eligible to receive a rating of at least 3 stars. Similar to national quality reporting programs due to the time needed to collect and analyze survey and clinical quality measure data, the data CMS uses to calculate star ratings is based on plan performance data from two years prior. When shopping for a plan in 2020, consumers should keep in mind that star ratings displayed on HealthCare.gov are generally based on how the plan performed in prior years.
HealthCare.gov will display the Overall Rating with the number of stars from 1 to 5 filled in towards the top of each plan, or let the consumer know if the individual plan hasn’t been rated. Consumers can see three additional star ratings for Member Experience, Medical Care, and Plan Administration which comprises the Overall Rating when selecting an individual plan’s detailed information along with other coverage and benefits. The Overall Rating and the three additional quality rating categories are also displayed when consumers choose to compare up to three plans side-by-side.
For more information, please see the Exchanges Quality Rating System fact sheet.
Summary information is provided in the Plan Year 2020 quality ratings results at a glance.
Expanded Streamlined HealthCare.gov Application
As part of the continued commitment to improving the customer experience, the streamlined application on HealthCare.gov is expanded this year to handle nearly all consumer applications, both simple and more complex eligibility scenarios. The streamlined application provides improved content and integrates help information throughout the application in order to provide a more seamless enrollment experience from start to finish, as well as enhanced mobile optimization. CMS will continue to make enhancements to the application based on consumer feedback and testing.
Visual Refresh of Consumer Shopping Experience
This year, the visual experience for consumers when they preview plans (“See plans & prices”) and shop, compare and enroll on HealthCare.gov has been refreshed based on consumer research and feedback. The visual refresh provides a more consistent user experience throughout the entire enrollment process on HealthCare.gov that includes updates to filters, the plan results list, improved help content and enhanced mobile optimization.
Enhanced Direct Enrollment (EDE) Expanded
Enhanced Direct Enrollment (EDE) will be available throughout the entire Open Enrollment Period for the first time this year. This key development allows CMS to partner with the private sector to provide more avenues for consumers to apply and shop for Exchange coverage. Through the EDE pathway, consumers have the option to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or to contact the Exchange Call Center. This year, more approved partners are offering EDE-capable websites. As of October 25, CMS has approved more than 5 private sector partners to operate an EDE pathway.
The safety and security of consumer information is our number one priority. Enhanced direct enrollment partners are required to undergo rigorous audits to ensure compliance with strict privacy and security controls prior to being certified to use this new platform. CMS continuously monitors each partner to ensure they remain in compliance with CMS requirements.
For more information please see the Enhanced Direct Enrollment Pathway for Health Insurance Exchange Coverage fact sheet.
New resources about Health Reimbursement Arrangements (HRA)
New rules released this year permit employers to fund individual market premiums for their employees through a new type of HRAs – Individual Coverage HRAs. CMS is adding educational information and a consumer worksheet tool to assist employees in determining whether to use an individual coverage HRA from their employer to help pay for coverage. HRAs are employer-funded accounts from which employees are reimbursed tax-free for qualified medical expenses.
For more information please see the Health Reimbursement Agreements webpage.
NEW THIS YEAR
Key Updates and Enhancements to Healthcare.gov for the 2020 Open Enrollment
Quality Rating Information Displayed in HealthCare.gov States
Quality ratings will be displayed on HealthCare.gov when consumers view the list of plans available in their area in HealthCare.gov states this year. Under the five-star Quality Rating System, Exchange health plans are given an overall rating on a 1 to 5 scale, with 5 stars representing highest quality. The overall star rating is based on three categories: Medical Care, Member Experience and Plan Administration. In some cases — such as when plans are new to the Exchange or have low enrollment — ratings may not be available.
Star ratings in the Exchange help make it easy for consumers to compare health coverage choices by giving consumers a snapshot of how each health plan’s quality compares to that of other Exchange plans in each state in a given year. A quality rating of 3 or above means that a health plan is considered average or above average as compared to other plans across the country. For the 2020 coverage year, 80 percent of plans eligible to receive a rating of at least 3 stars. Similar to national quality reporting programs due to the time needed to collect and analyze survey and clinical quality measure data, the data CMS uses to calculate star ratings is based on plan performance data from two years prior. When shopping for a plan in 2020, consumers should keep in mind that star ratings displayed on HealthCare.gov are generally based on how the plan performed in prior years.
HealthCare.gov will display the Overall Rating with the number of stars from 1 to 5 filled in towards the top of each plan, or let the consumer know if the individual plan hasn’t been rated. Consumers can see three additional star ratings for Member Experience, Medical Care, and Plan Administration which comprises the Overall Rating when selecting an individual plan’s detailed information along with other coverage and benefits. The Overall Rating and the three additional quality rating categories are also displayed when consumers choose to compare up to three plans side-by-side.
For more information, please see the Exchanges Quality Rating System fact sheet.
Summary information is provided in the Plan Year 2020 quality ratings results at a glance.
Expanded Streamlined HealthCare.gov Application
As part of the continued commitment to improving the customer experience, the streamlined application on HealthCare.gov is expanded this year to handle nearly all consumer applications, both simple and more complex eligibility scenarios. The streamlined application provides improved content and integrates help information throughout the application in order to provide a more seamless enrollment experience from start to finish, as well as enhanced mobile optimization. CMS will continue to make enhancements to the application based on consumer feedback and testing.
Visual Refresh of Consumer Shopping Experience
This year, the visual experience for consumers when they preview plans (“See plans & prices”) and shop, compare and enroll on HealthCare.gov has been refreshed based on consumer research and feedback. The visual refresh provides a more consistent user experience throughout the entire enrollment process on HealthCare.gov that includes updates to filters, the plan results list, improved help content and enhanced mobile optimization.
Enhanced Direct Enrollment (EDE) Expanded
Enhanced Direct Enrollment (EDE) will be available throughout the entire Open Enrollment Period for the first time this year. This key development allows CMS to partner with the private sector to provide more avenues for consumers to apply and shop for Exchange coverage. Through the EDE pathway, consumers have the option to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or to contact the Exchange Call Center. This year, more approved partners are offering EDE-capable websites. As of October 25, CMS has approved more than 5 private sector partners to operate an EDE pathway.
The safety and security of consumer information is our number one priority. Enhanced direct enrollment partners are required to undergo rigorous audits to ensure compliance with strict privacy and security controls prior to being certified to use this new platform. CMS continuously monitors each partner to ensure they remain in compliance with CMS requirements.
For more information please see the Enhanced Direct Enrollment Pathway for Health Insurance Exchange Coverage fact sheet.
New resources about Health Reimbursement Arrangements (HRA)
New rules released this year permit employers to fund individual market premiums for their employees through a new type of HRAs – Individual Coverage HRAs. CMS is adding educational information and a consumer worksheet tool to assist employees in determining whether to use an individual coverage HRA from their employer to help pay for coverage. HRAs are employer-funded accounts from which employees are reimbursed tax-free for qualified medical expenses.
For more information please see the Health Reimbursement Agreements webpage.
Helping Consumers Connect with Agents & Brokers
CMS will continue to partner with a third party to offer the “Help On Demand” services from agents and brokers. This service allows consumers to choose to request that an agent or broker in their area contact them directly for help applying and enrolling. Registered agents and brokers are able to set times when they’re available and then reach out to consumers who expressed interest in assistance.
Learn more about Help On Demand services.
Find Local Help
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. Consumers can search for a specific person or organization by entering their name and can filter the results based on their preferences and services provided. Additionally, consumers can filter agents and brokers by their minimum years of participation on the Federal Exchange.
Financial Assistance
Premium tax credits will be available in 2020 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.