When the Senate's plan to overhaul the nation's healthcare system collapsed early Friday morning, it ended—at least for now—the Republicans' seven-year effort to repeal and replace the Affordable Care Act.

But the ongoing uncertainty of the last several months has unsettled health insurers and consumers alike.

"I've been on tenterhooks all spring and summer," says Fred Taft of Georgetown, Maine. His senator, Susan Collins, along with John McCain of Arizona and Lisa Murkowski of Alaska, was one of three Republicans to break rank and vote against the party's latest healthcare bill. 

Taft says he has been on edge in part because his wife had a recent scare with a possible diagnosis of ALS, a rare and potentially deadly neurologic disease, and in part because he worried whether his family would still have access to coverage under the ACA.

"And frankly, while we finally do have a chance to breathe, I'm concerned that insurers may be so spooked that it will be harder to find coverage now."

And signing up for health insurance could be particularly challenging this year, especially for people who buy insurance on their own, says Chris Sloan, a senior manager in the policy practice at Avalere Heath, a healthcare consulting firm.

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“Consumers will have to deal with a lot of uncertainty. You need to be prepared for that,” Sloan says.

For one thing, even without legislation to repeal or replace the ACA, there are several steps that President Trump can take to hobble the law—and that could make signing up for an ACA plan harder this year.

For example, the Trump administration has already cut in half the open enrollment period for people who buy ACA plans to just six weeks, from November 1 to December 15, and cut back outreach efforts meant to encourage people to sign up for coverage.

Also, uncertainty about continued government funding for key cost-sharing subsidies has raised pressure on some insurers to raise premiums and prompted others to drop out of the market entirely. Even insurers who've said they will participate on the exchanges could drop out before open enrollment begins.

All of which means that you should start planning extra early this year, especially if you don't get insurance through your employer or Medicare.

Here are the steps you can take now to avoid headaches later and ensure you get the best plan.

Your Guide to Open Enrollment

Get needed medical care now. Consider scheduling care you need soon, before the year runs out. That's because your deductible—the money you must spend before your insurance kicks in—resets in January. So if you have already met your deductible or are close to the limit, schedule care now to take full advantage of your current coverage.  

Check your healthcare needs. Because premiums next year are likely to be higher, along with your deductibles and other out-of-pocket costs, you may need to budget now for those higher costs.

Look at what you’re currently spending on premiums, what your plan covers, and how much you are spending out of pocket. Try to project what care you’ll need next year.

For example, if you have a chronic health condition or are planning a pricey treatment—say, a knee replacement—calculate what you have spent in the last year or research the procedure's cost to you after insurance. Then build in a buffer for next year, assuming that you'll have to pay more.

Mark your calendar. The Trump administration has cut in half the open enrollment period for people who live in one of 36 states that did not set up their own health insurance exchanges. In nearly all of those states, open enrollment will be just 45 days, down from 90 days, and will run November 1 through December 15.

The administration has also cut back efforts to advertise open enrollment this year, as well as other outreach efforts, so it will be easier to miss the deadline. Last, if you do miss the deadline, the Department of Health and Human Services has also made it harder to get waivers so that you can sign up later.

Note that 15 states and Washington, D.C., run their own exchanges and may provide more time and different dates for open enrollment. So check in with your state health insurance website regularly to see whether it has posted its enrollment period.  


Are you worried about your healthcare costs? Join Consumer Reports’ efforts to #ProtectOurCare.
 

Shop around. If you had a plan in 2017, don’t automatically re-enroll in the same one, because it may not be the best option for you this year. 

And when you're choosing a plan, keep in mind that about two-thirds of people qualify for help paying for out-of-pocket costs like co-pays for drugs and office visits—but you can only get that assistance if you sign up for a "silver," or midlevel, plan.

If you live in an area with no insurer offering an ACA marketplace plan for 2018, you can still buy a plan on the private market from an insurance broker or directly from an insurance company. But you won't be eligible for a subsidy to reduce your premium. Note that a private plan may tempt with a low premium but offer very high deductibles and less comprehensive coverage.

Get your due. Tax credits can drastically reduce ACA premiums. For example, the average premium for an individual silver plan with a tax credit is as low as $75, but without that subsidy the average premium is $433. Yet half of uninsured adults don't know that they can claim those tax credits, according to a Commonwealth Fund report.

And many others don't know that they can get help covering out-of-pocket costs, either. More than 1 million people could have gotten those benefits in 2016, according to a report from the Department of Health and Human Services.

To find out whether you qualify for financial assistance, go to healthcare.gov.

Enlist help. Insurance plans are complex, and choosing the one that suits you best can be challenging. You can get help enrolling and comparing plans by phone or with a local in-person guide, called a navigator. ACA marketplace call centers are available 24 hours a day, every day except holidays. At healthcare.gov, you can search by city and state or ZIP code to see a list of local organizations that can help you.