Obamacare open enrollment to begin amid shaky insurance market

Open enrollment for health care coverage next year begins next week amid uncertainty over the future of the Affordable Care Act and big increases in premiums for individuals and businesses that do not qualify for subsidies.

Nevertheless, the health care law is still in effect and those required to enroll in a plan will face increasing penalties by the Internal Revenue Service if they fail to do so.

Connecticut’s health insurance exchange, Access Health CT, is preparing for a shortened enrollment period that begins on Nov. 1 and ends on Dec. 22 of this year.

Those who aren’t covered through their employment or government-run plans like Medicare and Medicaid are urged by Access Health CT officials to shop for a policy on the exchange from the two insurers that participate, Anthem and ConnectiCare. Many, but not all, will be eligible for subsidies that will offset the sharp increase in this year’s premiums.

This year, nearly three-quarters of Access Health customers received discounts. Higher premiums from one year to the next will lead to higher subsidies. So, many customers receiving discounts probably will see a smaller increase than the change in sticker price for their plans – or no change at all.

Those who earn too much money to receive discounts, however, will notice a sharp increase in the cost of their premium, leading to concerns the number of uninsured will rise next year.

Andrea Ravitz, Access Health’s director of marketing and sales, urges people to shop around.

“The plan that you had last year might not fit your needs right now,” she said. “For a lot of us, it’s really easy to say to renew what I had, I’m fine, but life-changing events should be something that we take very seriously.”

Ravitz said changes in income can result in changes in eligibility for financial help, which is determined by income, age and location.

Individuals and small businesses also can purchase insurance off the exchange, where there are many more choices and plans may have a larger network of health care providers, meaning a wider choice of doctors and hospitals.

But plans purchased outside of Access Health CT are not eligible for premium subsidies or other federal help.

If you don’t have health care coverage in 2018, you’ll have to pay a fee when you file your taxes in 2019. The penalty for being uninsured in 2017 is either 2.5 percent of household income or $695 per adult and $347.50 for each child, whichever is higher.

If you have coverage for part of the year but are uninsured for the rest, the penalty is pro-rated. There are exemptions from penalties for those who are uninsured for fewer than three consecutive months or have very small incomes.

Those eligible for Medicaid, the joint federal-state health plan for the poor known as HUSKY in Connecticut, may also enroll through Access Heath CT. But individuals and families can enroll in HUSKY throughout the year. They are not limited to the open enrollment period.

Expect higher premiums

Premiums have increased this year because of several factors. Medical costs have risen, customers in state ACA exchanges are older and sicker than expected, and the Trump administration has ended payments to insurers known as cost-sharing reductions (CSR). Those payments offset the cost to insurers that lower deductibles and co-payments for low-income Americans who purchase certain policies in state exchanges.

Under the law, insurers must continue lower out-of-pocket costs for those who qualify, but they will no longer receive money from the federal government – unless Congress acts to offset their losses. Nationally, the loss of CSR payments has increased premiums by an average of 20 percent, adding to hikes in the cost of an insurance policy for other market reasons.

The greatest premium increases are in mid-level, “silver”-tiered plans, the only ones that were eligible for the cost sharing reduction program. Anthem has increased the cost of these plans by an average of 41 percent, and ConnectiCare by nearly 32 percent.

For example, a 46-year old living in Hartford would pay about $568 a month for a ConnectiCare silver plan, and $655 a month for an Anthem silver plan next year, if they were not eligible for a premium subsidy.

But if that 46-year-old earns $36,500 a year, his or her monthly premium would drop to $290.25. And the cost of coverage would decrease with income, so if that person’s annual income was only $17,500, the monthly premium would be $54.01.

The silver-tiered plans are the most popular in Connecticut. More than 60,000 of the 96,000 enrollees in Access Health CT this year purchased a silver plan.

But there will be increases in the premiums in most other individual and small group policies as well.

But there may be a way for these premiums to be reduced before policy coverage period begins on Jan. 1. A bipartisan plan in the Senate aims to restore the CSR payments for two years, as well as make other changes to Obamacare.

“If facts and circumstances change we will look at the issue,” said Connecticut Insurance Department Commissioner Katharine Wade. “Our hope is that In the event that legislative action is taken that we will be given the flexibility to re-adjust the rates.”

President Donald Trump’s decision to end CSR payments also has provoked more than 25 states, including Connecticut, to sue to have them restored. Opening arguments in the case were heard in a federal court on Monday.

Enrolling in a plan, from platinum to bronze

In ACA’s state exchanges, like Access Health CT, insurance plans are identified by metal tiers — bronze, silver, gold and platinum.

The platinum plans, which are not available in Connecticut, are the most expensive and offer the broadest coverage and fewest out-of-pocket expenses.

Bronze plans are at the other end of the metal spectrum. They generally have the lowest monthly premiums and the highest co-payments and deductibles.

Those who are under 30 years old can choose catastrophic plans, which have the lowest premiums and require the highest spending when people get care.

But under the Affordable Care Act, certain preventive services, including annual exams and mammograms, must be covered at no charge to a patient, regardless of the plan they choose.

Those shopping for a new health plan can call their doctor to make sure he or she is enrolled in a plan and check to see whether medications they take would be covered under that plan before making a decision.

Oher out-of-pocket costs like deductibles and co-pays should also be considered. Another thing should be taken into account —  those who earn no more than 250 percent of the federal poverty level, or $61,500 for a family of four, who enroll in silver plans could have those out-of-pocket costs subsidized, making a silver plan for those who qualify more economical than a bronze plan.

Access Health CT has a tool designed to help explain the costs associated with each plan, based on medical needs.

The goal, Access Health CT says, is to avoid ending up with a plan that may have a lower price point but ends up being more expensive because of higher co-pays, deductibles or the cost of prescriptions.

Access Health CT said it has hired 200 call center workers and is training them to answer questions of new enrollees and those who are re-enrolling.

The state exchange hopes to hold five enrollment fairs this fall. Instead of storefront offices, it is opening 10 less costly enrollment centers where people can get walk-in help this year.

There are also about 250 certified private insurance brokers in the state that can help people enroll in a health plan, on or off the exchange. Access Health CT hopes the number of brokers, who are paid commissions by insurers, will grow.

The future of Obamacare

While Trump said the ACA exchanges are “dead,” they are in operation this year. GOP proposals to repeal and replace Obamacare, which failed to garner enough votes in the Senate, allowed for the health care plan to continue for two more years.

There is also an effort to stabilize the nation’s insurance markets and shore up the Affordable Care Act for at least two years.

The bipartisan effort in the Senate would re-establish CSR payments, allowing for the chance premiums in Connecticut could drop next year, and give states more flexibility to drop some ACA regulations, as long as certain coverage goals are met.

The plan also would allow state exchanges to sell new “copper” plans that cost less and have higher out-of-pocket costs than “bronze” plans.

But the fate of this effort is unclear.

Senate Majority Leader Mitch McConnell said Sunday he’d be willing to bring the compromise to the floor — if Trump makes clear he supports it.

But Trump has offered mixed signals, alternately praising and condemning the efforts toward a bipartisan solution.

Access Health CT Hartford County standard plan rates for a family of four

Insurers are ConnectiCare Benefits (CBI) and Anthem

Mirror health reporter Mackenzie Rigg contributed to this story.