Insurance experts expect moves from lapsed Medicaid recipients to ACA plans

April 1 saw the end of the pandemic-era extension for Medicaid and Children's Health Insurance Program (CHIP) coverage. Recipients who didn't need to reapply for the programs during the early years of covid had to complete an annual renewal to see if they were still eligible for coverage.

If they no longer qualified for Medicaid, they had to find other insurance — either through their employer, CHIP or Medicare or through a program such as the Affordable Care Act.

Months later, as 2024 enrollment began for Affordable Care Act last week, many former Medicaid enrollees are exploring Pennie.com, Pennsylvania's online health care marketplace.

Since July, Pennie has enrolled almost 13,000 people who had been on Medicaid into ACA marketplace plans. Participants can sign up immediately after losing coverage, said Louise Norris, health policy analyst for the nonprofit healthinsurance.org.

But even those who already enrolled in ACA after losing Medicaid will need to check the site again to renew coverage for 2024, she said.

"It's (coverage is) still going to end at the end of December and renew to a new policy for Jan. 1," Norris explained. "All of those folks who have come into Pennie plans, they still need to go back into their Pennie account and look and see what is changing for 2024."

More people may be signing up for ACA plans this year because of the Medicaid "unwinding" period that started April 1, she said.

"We are going to see an overall increase in volume in terms of the total number of folks signing up for ACA marketplace plans this winter," she said.

Help from assisters

Laura Bellan, care manager supervisor at Sto-Rox Neighborhood Family Health Center, says figuring out a new insurance system can be overwhelming. Many people also didn't realize they had to renew their Medicaid, meaning that since they lost coverage, they've been in a health care gap, she said.

"I know that they sent out letters, but I don't think people understood," she said.

As an "assister," Bellan is trained in helping people use Pennie.com. A help page on the Pennie site directs people to assisters and brokers in their area who can help decipher ACA insurance, often for free.

"Open enrollment started (Wednesday), and I've already had two people (reach out) concerning that," Bellan said. "We do expect to be busy. I just have another one of my staff members going through the Pennie course right now so that she can be a certified Pennie assister as well. That would be three of us at our center."

At Community Health Clinic, which has locations in Vandergrift, New Kensington and Greensburg, Kia Bell, enrollment and outreach specialist, says she has 10 to 15 people daily seeking help with Medicaid enrollment.

"I am experiencing a very high volume of Medicaid renewals, especially a lot with older citizens. They don't know that they need a renewal, and their insurance just kind of ends," she said. "We have a lot of sit-downs, where I do have to explain to them what's going on, and that they'll need to do a renewal, and that now this is required, when it wasn't required last time because of covid."

At healthinsurance.org, Norris recommends people seek out a broker or assister early on.

"I would just recommend getting on their calendar sooner rather than later — if you wait until Dec. 14, it's tricky to find someone who can help you at the last minute," she said. "Most people do it online or over the phone, but there are in-person enrollment assisters too who can help with that."

Insurance companies advise

Joseph Bayura, senior director of consumer products at UPMC Health Plan, said the transition away from pandemic-era Medicaid policies has been "pretty chaotic."

"It's been a huge population of people impacted, and difficult to really understand the overall impact for individuals, with a number of them eligible for other programs like CHIP," he said. "The most important thing for them to understand is there's a lot of resources out there to help them with that transition, and make sure they understand that subsidies have been enhanced."

By subsidies, Bayura means discounts and financial help, some of which were made possible by American Rescue Plan Act funding through 2025.

"The vast majority of people enrolled in individual and family plans are eligible for some sort of subsidy," he said. He noted that experts with UPMC, Pennie assisters and elsewhere can help people learn about discounts they may be eligible for.

Bill Tuthill, Highmark's vice president of market strategy for federal markets, said he already has seen people moving from Medicaid to plans through the ACA.

"We are seeing it already, because states started the Medicaid redetermination process in the spring, and really in full swing in the summer," he said. "We've started seeing each month, gradually building through October and likely November, a lot of people in Pennsylvania that are coming off of Medicaid and choosing ACA coverage as the way to avoid gaps and care and maintain access to their doctors. We are seeing a lot of that just month-to-month."

Both Tuthill and Bayura recommended that people take a close look at what plans are available through the Pennie site and consider what is best for them and their needs.

"If you're someone engaged with the health care system now, and you have a primary care provider, you take one or two medications to help you maintain your health, on Pennie's website, you can put your doctor in and put your drugs in, and first thing, make sure that your doctor accepts the health plan and that those drugs are covered by the health plan," Tuthill said.

"Highmark offers a lot of plans, and other carriers offer a lot of plans," he said. "We are seeing more people choose to enroll with the help of an expert. People should know that there are tons of resources out there."

Bayura suggested people think over whether to choose a narrow network plan or one that allows for more out-of-area coverage.

"There's no reason to take on more than you need," he said. "You still have a lot of folks who enroll in products that have out-of-area benefits when they're here in Pa. Don't overpay for something you don't need."

Norris noted that people losing Medicaid should keep track of the monthly premium payments on their new ACA plans.

"Set on automatic payments, or set yourself a calendar reminder — you don't want to forget to pay your premium," she said.

She also advised new recipients to pay close attention to the details of different types of plan.

"Sometimes it might be very attractive to look at bronze plans that (have no premium), but they might have $9,000 in total out-of-pocket costs ... you might qualify to a silver plan, where you have to pay a little more in premium and have a lot lower costs when you need care," she said.

"You just have to sort of weigh the pros and cons. ... You want to know what exactly you're getting so that it doesn't come out of nowhere and surprise you that you have this multiple-thousand-dollar deductible when you need care."

Julia Maruca is a Tribune-Review staff writer. You can contact Julia at [email protected].

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