'A good start'

HEALTHCARE

Blanca Bonilla was trying to help an older couple find health insurance they could afford after the husband was laid off from his job in the northern Shenandoah Valley.

They weren't old enough for Medicare coverage and earned too much for other public health subsidies, and Congress had allowed enhanced federal health insurance premium subsidies to expire at the beginning of this year.

Bonilla, who has worked as a health insurance navigator at Enroll Virginia! in Winchester for six years, looked at the options, which this year include financial aid that Virginia is providing to offset the loss of the federal subsidies to make insurance premiums more affordable.

She found a plan that covers both of them for $130 a month, with a relatively low deductible threshold before insurance starts to pay. The couple is also eligible for reduced cost-sharing requirements, such as copayments or out-of-pocket maximum costs.

"It is really rewarding to see the relief on their faces knowing that despite everything they had been through they were able to find coverage they can afford," Bonilla said in an online news conference sponsored by the Virginia Health Insurance Marketplace and Enroll Virginia! on Monday.

"So they can go into the new year with the peace of mind knowing they both will have health insurance without having to stretch their limited income to pay for it," she said.

The Virginia Premium Savings Program is already helping offset the loss of enhanced federal health insurance premium subsidies in January. The General Assembly and Gov. Abigail Spanberger provided $150 million in state funds in the budget to help Virginians find affordable health insurance after 73,000 people dropped coverage earlier this year.

A week after open enrollment began for health insurance in 2027, Enroll Virginia! already is seeing signs of hope, even though it's too early to know how many people will return to the state-run marketplace for health insurance through the Affordable Care Act.

"We are definitely seeing a lot of Virginians coming back to the marketplace this week and seeing very much reduced prices, particularly for low-income Virginians," said Deepak Madala, director of the statewide system of navigators who help consumers find health plans they can afford.

So does the Virginia Health Benefit Exchange, which runs the state marketplace within the State Corporation Commission.

"We're already seeing the impact," said Holly Mortlock, deputy director of the exchange. "Thousands of Virginians have already qualified for health plans costing $25 or less for 2027."

The new state program works in tandem with federal aid that remains after the loss of the enhanced subsidies, which the government initially adopted during the COVID-19 pandemic.

"Even if you don't qualify for help, you can still be eligible for savings through the Virginia program," Mortlock said.

The new state program doesn't benefit everyone who previously qualified for the enhanced federal subsidies, which had applied to incomes as high as 400% of the federal poverty limit, or $132,000 for a family of four.

Virginians are eligible for state help with premiums if they earn between 138% and 250% of the federal poverty limit. For a single person, that's $22,025 to $39,900 a year. For a family of four, that's $45,540 to $82,500 a year.

It also won't help some legal immigrants — such as refugees, asylum seekers and those with temporary protected status — who won't be eligible for any federal premium tax credits for health insurance after Jan. 1 under the sweeping tax cut package that President Donald Trump signed into law last year.

Bonilla has been trying to help some affected immigrant families in the Winchester area, but even with assistance from the new state program, they still can't afford the monthly premiums.

"Most families in that situation are choosing to go without insurance for 2027," she said.

Last year, about 370,000 enrolled in health plans through the state marketplace for coverage in 2026. After the enhanced federal subsidies expired, those monthly premiums suddenly became less affordable. By June, only 297,000 people remained covered.

Their departure affected the cost of insurance premiums that Virginia consumers will pay for coverage next year. Premiums rose an average of 16.7%, depending on health plan, because the people who left the insured pool were healthier than those who remained.

"Sick people won't leave because they can't — they need the coverage," said Doug Gray, executive director of the Virginia Association of Health Plans.

The new state premium savers program "doesn't apply to everyone," Gray said, but "it's a good start."

"Getting people to take another look is really important," he said.

Madala said people who return to the marketplace this year are "pleasantly surprised" by the options they see for plans they can afford.

In Winchester, for example, Bonilla helped a woman on Monday morning who had purchased health coverage through Cigna, which is no longer participating in the Virginia marketplace in 2027.

The woman, who earns about $30,000 a year, was not aware of the new Virginia program and how it could help her.

With the combination of federal tax credits and state premium savings, Bonilla found a "silver plan" — one that's moderately priced with a relatively low deductible — that will allow the woman to cut her monthly premium by more than half. Instead of $189 a month, she'll pay $75 a month. It will cover all of her medications and allow her to keep her providers.

The woman is self-employed, so "there's no other healthcare option for her besides the marketplace," Bonilla said. "It's one of the best success stories I've seen."

Michael Martz (804) 649-6964 mmartz@timesdispatch.com

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