ACA options expand in N.C. More insurer options available for North Carolinians on federal ACA health exchange

The 2022 open enrollment period begins Monday for the federal health insurance exchange with a sign-up period again scheduled to end Dec. 15.

Individual plans are offered under the federal Affordable Care Act, commonly known as "Obamacare." In each case, coverage begins Jan. 1.

Individual rates vary based on location, age, subsidy amount and plan. Subsidies are available for customers with household incomes between 100% and 400% of the federal poverty level.

There were 535,803 North Carolinians enrolled for 2021 through the exchange - the fourth highest total in the country and the highest for the state since 2017.

"Open enrollment is an opportunity for residents to choose the best insurance plan to meet their needs if they do not have health insurance through their employer or through private means," state Insurance Commissioner Mike Causey said in a statement.

The department has a hotline - (855) 408-1212 - to handle ACA enrollment questions.

"This year, consumers may be able to tap into subsidy enhancements to provide tax credits that may be larger than last year to offset premiums," Causey said. "There is also no income cap for subsidy eligibility."

For 2022, the federal American Rescue Plan includes subsidy enhancements that is expected to bolster enrollment in North Carolina and nationally.

The number of N.C. participants in the federal health exchange could be cut drastically if North Carolina approved expanding Medicaid coverage to between 450,000 and 650,000 residents.

However, state Republican legislative leadership has shown little, if any interest, in taking that step.

There are 39 states with some form of Medicaid expansion, with the rest mostly in the Southeast.

New entrants

Eligible North Carolinians have four more ACA exchange insurer options for 2022 for a total of 10.

The new entrants are Aetna CVS Health, AmeriHealth Caritas, Celtic/WellCare and Friday Health Plans.

The returning insurers are Ambetter/Centene, Blue Cross Blue Shield of N.C., Bright Health, Cigna, Oscar and United Healthcare.

Blue Cross NC, by far the largest provider to date, said in August it would have an average 2.8% rate increase.

Blue Cross typically is the only ACA insurer to provide coverage in all 100 counties. It expects to enroll about 475,000 customers for 2022.

By comparison, Friday Health Plans Inc. debuts in 2022 with plans to cover five Triad and Northwest N.C. - Alamance, Guilford, Randolph, Rockingham and Watauga - as part of 40 counties overall.

Eligibility

The federal Eligibility for Advanced Premium Tax Credit subsidies is determined through the enrollment process at www.healthcare.gov.

The state Insurance Department said North Carolinians "are guaranteed to be insurable and are encouraged to sign up for health insurance if they meet one of the following conditions."

• They have current qualifying ACA coverage, but may want to change their plan for 2022;

• They don't have health insurance through their employer or their spouse's employer;

• They don't have government coverage, such as veterans, Medicare and Medicaid; or

• They are older than age 26 and can no longer be on a parent's health insurance.

Also, short-term health plans can be sold in North Carolina with initial plan terms up to 364 days.

Outside the open enrollment period, North Carolinians who buy health insurance from the ACA may enroll in an insurance plan only if they qualify for a special enrollment period because of life events, such as having or adopting a child, losing health coverage or moving to a different service area.

Background

When ACA health exchange plans debuted in 2014, there was concern that the initiative wouldn't be financially viable for insurers, or that insurers would come and go depending on their revenue stream.

Indeed, Aetna and UnitedHealthcare exited North Carolina at the end of 2016.

In 2017, the Trump administration drastically cut federal funding for publicizing the enrollment period. North Carolina received just $500,000 after getting $3.4 million in 2018.

But as the federal exchange proved stable, UnitedHealthcare rejoined for the 2021 enrollment year and Aetna returns this year through its parent company CVS Health.

"In 2017 and 2018, insurers were fleeing the marketplace, but this year, things are different," said Louise Norris, a licensed broker and analyst for healthinsurance.org.

"Based on the rate filings that healthinsurance.org has analyzed thus far, we anticipate that many - if not most - marketplace enrollees will have more plan options available for 2022 than they had this year."

Blue Cross said the statewide rate increase for 2022 represents the balancing act between higher prescription drug costs and medical expenses for ACA participants, and lower costs gained from the shift toward value-based care.

The insurer said that Blue Premier, its value-based care program, has generated cost savings and quality improvements totaling more than $300 million in its first two years.

"Our move to value-based care continues to positively impact our members, even as health care costs rise," Tunde Sotunde, Blue Cross NC's chief executive, said in a statement. "While the average ACA rate for individuals will reflect a modest increase in 2022, the last three years Blue Cross NC lowered rates for individual ACA customers.

"This resulted in a total reduction of over $380 million since 2018 and a savings of $35 million in health care costs for 2021 alone."

336-727-7376@rcraverWSJ