Obamacare options contracting and getting more expensive
December 27, 2015 6:45 am • SUZANNE ADAMS-OCKRASSA Sun Staff Reporter
Next year may be the year that the U.S. government has to take a hard look at the Affordable Care Act and make some changes, said Ed Gussio, the president of Benefit Logic, Inc. in Flagstaff.
Individuals who need health insurance or need to make changes to the health insurance they purchased through Healthcare.gov have until Jan. 31 to make those changes or purchases.
Benefit Logic helps businesses and individuals navigate the maze of health, auto, life, dental, vision and travel insurance products. The company is also one of several in the area that offer free help in choosing an insurance plan on the Health Insurance Exchange at Healthcare.gov.
Byron Lewis, the health benefits navigator at North Country HealthCare, said while the ACA has had some growing pains there are lot more people who now have access to health care than before.
Lewis and the other navigators and application counselors at North Country also provide free help to people looking to purchase a health insurance plan at Healthcare.gov.
“We don’t charge a fee. We’re not a brokerage and we don’t get a kickback from the insurance companies if you sign up,” he said.
About 96 percent of people who signed up for health insurance through the Exchange last year are renewing their policies this year, Lewis said. And some people have also kicked the tires on the policy they have and want something different.
Last year, 86 percent of those who signed up through the federal exchanges received tax credits on their insurance premiums. The credits are available for families earning up to 400 percent of the federal poverty level. For a family of four, the income limit would be about $94,000; a family of two, $62,000.
Both Gussio and Lewis said they have had people come to them for help finding a new health insurance company through the Exchange after their old plan was no longer available, changed or increased in price.
For example, Gussio said, Blue Cross Blue Shield of Arizona has changed all of the plans it offers through Healthcare.gov from preferred provider organization (PPO) to health maintenance organization (HMO) plans, Gussio said. This startled a lot of people because under an HMO you have one primary care physician who must refer you to any specialists for care they can’t provide, except in the case of an emergency. Visits to health care professionals who are out of your health insurance’s network may not be covered by your insurance.
In a PPO you may not need a referral and can also go outside of your network for care, although you may pay more than if you went to a doctor that is in your insurance network, he said.
Gussio said he had a number of Blue Cross Blue Shield customers come to him with concerns about not being able to access care while they were on vacation or visiting an out-of-state relative or having to log onto Healthcare.gov to report the change.
Once he explained that Blue Cross Blue Shield had a national network that included a long list of providers in each state, many people realized that they wouldn’t lose insurance coverage if they traveled.
Other customers found themselves starting over from square one when their insurance company pulled out of the Health Insurance Exchange or was dropped from the state exchange, like Meritus, Gussio said. Meritus, a nonprofit health care cooperative, was actually removed from the list of approved insurance companies in the Arizona Health Insurance Exchange because the state was concerned that Mertius might not continue to be solvent in 2016. Meritus will close for good on Feb. 1, he said.
Some private, for-profit insurance companies that offer plans through the Exchange are facing the same financial strain, he said. United Healthcare announced this year that it would probably would not offer plans on the Exchange in 2017.
According to the Kaiser Family Foundation, 36 percent of counties in states using Healthcare.gov will see a net decrease in the number of insurance companies that offer coverage within their borders, about 17 percent will see an increase and the bulk will remain the same. There is a total of 2,603 counties that use Healthcare.gov.
The Flagstaff area went from 56 plans offered by a variety of insurance companies for individuals to 19 this year, Gussio said.
People also are seeing an increase in their health insurance premiums, Gussio said.
“The costs for individuals is unbelievable,” he said. “We’ve seen some very, very high premiums. I haven’t seen an increase this big in the 20 years I’ve been working in the industry.”
Most of the families purchasing policies sold on the federal exchanges, even those more expensive, will be eligible for tax credits, based on previous years' experience.
Some individuals have seen premium increases of more than 20 percent and some businesses have seen 40 to 60 percent increases, Gussio said. There have also been some decreases in premiums, but the majority of price changes have been increases.
According to a Kaiser Foundation poll of 1,202 adults between the ages of 18 and 64, 46 percent said they tried to get health insurance but found it was too expensive, even with government subsidies.
The increases are partially due to the number of health insurance companies that are going under or are merging with other companies, he said.
Many people are saying they would rather pay the penalty for not having insurance at all rather than pay $1,400 a month for insurance they may not use, Gussio said.
That’s despite the fact that the average penalty for an individual not having insurance in 2016 will increase 47 percent to $969, according to a recent analysis by the Kaiser Foundation. The average penalty in 2015 was $661.
Lewis said for a family of three, two adults and a child, the penalty starts at around $1,737.
“That’s school clothes or a house payment,” he said. “I have not found a person who doesn’t want health insurance. They want to be able to afford it. We’re trying to show people what’s available.”
However, Lewis said, even with the price changes he has not had a problem helping people find a new health insurance carrier. In some cases, he’s been able to help them find the same plan under a different company at a cheaper price.
Businesses with 50 or more employees are also looking at paying the penalty rather than purchasing health insurance for their employees, Gussio said. He’s had a handful of business clients come in asking about the 50 or more employee mandate that goes into effect in 2016.
Businesses with fewer than 50 employees are exempt from having to provide health insurance. Those who do can receive government subsidies under the SHOP program.
In some cases, it’s cheaper to pay $2,000 per employee per year and give them the money to buy through the Exchange than it is for the larger employer to purchase a plan, he said.
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