It has happened every fall, for five years in a row. After spending months figuring out her insurance deductibles, doctor networks, drug lists and other fine print, Cyndee Weston has received notice that her policy will be canceled as of Dec. 31 — and she must start over.
“It’s agonizing going through all the plans and trying to compare,” said Ms. Weston, 55, whose job doesn’t come with insurance and who has diabetes and a history of melanoma. “Every year it’s the same scenario: ‘We’re not going to renew your policy.’”
Under the market-based system set up by the Affordable Care Act, individuals are encouraged to shop around each year to find the insurance that best suits their medical needs and income. But the reality is that many people — among them Ms. Watson, a trade-association executive in Sulphur, Okla. — end up being forced to shop around, again and again, when insurance plans drop out of the local market or eliminate preferred hospitals and doctors from the network.
The Affordable Care Act has increased the number of Americans with health insurance by 20 million, and cut the uninsured rate to 9 percent. But the task of finding new insurance annually can complicate care for some people, particularly those with continuing medical needs or chronic conditions. This issue became complex in new ways this year given the uncertainty introduced by the administration of President Donald Trump, whose threats to repeal or rein in the law have spurred turmoil in many state and local insurance markets.
“There’s quite a number of people who are either temporarily uninsured or they move into different plans” each year, said Marianne Udow-Phillips, head of the Center for Healthcare Research and Transformation (CHRT) at U-M. “And I’m guessing this year that will be much greater, given all the changes that are happening in the marketplace plans.”
Fewer than half the people with marketplace insurance in 2014 stayed in the same plan the next year, according to a Michigan survey done by Ms. Udow-Phillips and colleagues. Nearly a third of marketplace enrollees for 2017 were new customers, meaning they had other kinds of coverage previously or were uninsured. For the 2018 enrollment season, which began on Nov. 1 and ends Dec. 15 in most states, millions of people will switch coverage.
The imperative to shop for insurance affects mostly those who buy it for themselves, for instance small-business owners and people who are self-employed. Enrollment for 2018 through online marketplaces has been particularly complicated because of premium increases for some plans, the mistaken belief that the health law was fully or partly repealed, and the administration’s decision to terminate $7 billion in subsidies.