More Americans expected to enroll in Affordable Care Act health plans as costs drop, benefits increase [The Tribune-Review, Greensburg]

Nov. 14—If you've shopped the Affordable Care Act marketplace for a health plan in recent years only to be disappointed by its price tags, you might want to try again.

More Americans than ever qualify for federal subsidies to reduce what they spend on health insurance in 2022 — including millions who are under 65 and self-employed, run a small business or don't have an employer who offers sufficient benefits.

"There's more plans out there that can meet your needs, and they're more affordable than ever," said Joseph Bayura, director of product development for individual and small group sales at UPMC Health Plan.

In Western Pennsylvania, the 2022 market offerings bring more, lower-priced options coupled with enhanced benefits, such as $0 monthly silver-tier plans, virtual-focused plans with $0 telehealth copays and more choices for residents in rural counties.

"We're seeing an average of $100 lower premium across the board," said Bill Tuthill, vice president of market strategy for federal markets for Highmark, which along with UPMC offers ACA plans across Western Pennsylvania.

In addition to reductions in premiums and copays, plans are offering more perks like dental coverage, hearing aids and new types of packages tailored to certain types of health care priorities.

A new UPMC plan provides free virtual care visits for not only mental health but also primary and urgent care appointments. Tuthill points to some Highmark plans featuring a service that will send a helper to someone's home to help with housework or yardwork for a few hours.

Highmark has expanded into new territory for its ACA-backed insurance plans — including with a new narrow-network plan now open to Westmoreland County residents, just as Highmark's Allegheny Health Network builds out more medical facilities there.

"That's huge for us," Tuthill said. "Westmoreland County is a community that we love, and we have not had that low-cost option there in a few years."

Enrollment is open through Jan. 15, 2022 — though plans must be purchased by Dec. 31 for coverage to begin on Jan. 1 of next year. Pennsylvanians can enroll in ACA-compliant health insurance plans via the state-run exchange at Pennie.com.

Here are five things to know about the 2022 individual ACA health insurance shopping:

There's no more so-called 'subsidy cliff.'

A large swath of people who previously were excluded from getting subsidies now could be eligible, and the discounts people of all incomes get have grown heftier across the board — thanks to regulatory changes and cash infusions folded into the American Rescue Plan Act passed by Congress in March.

"The American Rescue Plan really boosted the subsidies," said Louise Norris, an individual health insurance broker affiliated with consumer research HealthInsurance.org.

In addition to infusing $1.9 trillion toward pandemic relief, the legislation made a significant change by axing the so-called "subsidy cliff" that restricted the contributions to those making under 400% of the federal poverty level. Last year, people excluded from subsidies included those making more than $51,520 a year for an individual, more than $69,680 for a couple or more than $106,000 a year for a family of four.

The Congressional Budget Office estimates that an additional 1.7 million people — most of whom are currently uninsured — could enroll in health plans through the marketplaces in 2022 as a result of the enhanced premium subsidies.

The elimination of the income-based cliff, however, doesn't mean that everybody gets a subsidy. Eligibility still hinges on financial need based on health costs not exceeding 8.5% of household income. So if an ACA benchmark plan's annual premium costs already are less than 8.5% of what you make, you won't qualify for the federally subsidized discount.

Even if you already liked your prior ACA-backed plan, you'll probably want to shop again.

That's because the 2022 offerings demonstrate across-the-board slashes to premiums combined with better benefits packages than recent years, particularly in comparison to 2016, 2017 and 2018, when many insurers left the market and small insurers that had focused only on the ACA market foundered.

"For the people that have been in ACA or the people who have always been eligible for ACA subsidies but have for whatever reason not entered the market, the economics for them is totally different," Tuthill said.

Don't forget about access — and in-network versus out-of-network — if choice doctors and facilities covered by your plan matters to you.

The two primary insurance providers in the Allegheny County area and much of Western Pennsylvania are Highmark and UPMC. Both reported upticks in enrollment during the pandemic-spurred special enrollment period and the first few weeks since the 2022 plans became public.

"One thing that covid taught us is the importance of having insurance for the unexpected," Bayura said.

Each offers limited-network plans that could save you money, but the savings might not be as valuable to some as keeping their doctors or the right to choose where to go for care.

Not long ago, UPMC dominated the ACA individual market in the region and was the only option in many areas.

Highmark self-reports that it had just 5% of market share across Western Pennsylvania back in 2019, after yanking its ACA plans in more than a dozen counties during uncertainty around the future of the marketplace in 2016. By next year, Highmark officials said they expect to claim closer to 20% of the region's ACA individual market.

"We estimate that we are getting a very large share of new shoppers that are coming in for the first time," Tuthill said. "Obviously, UPMC has all these members that have been with them for a long time, and so many of them are happy with it and they're staying there. But when people shop, they often change. So we expect that market share to go up pretty vertically this year as well."

Last year, UPMC was the only option in at least six rural counties in which Highmark now offers alternatives.

More buyers are going for the 'gold' tiered plans to get more bang from their extra federally subsidized bucks.

With their larger subsidies to spend, more individual insurance shoppers are opting for slightly pricier, higher-level plans rather than going for the cheapest option, according to initial data and local insurance representatives.

"The American Rescue Plan is putting more dollars on the ACA credit card that people have to spend," Tuthill said. "What we're seeing more than we even expected is people saying with that extra $100 bucks a month, I'm actually going to use it to buy a better plan."

A few years ago, less than 10% of shoppers opted for gold plans at Highmark, according to Tuthill. In 2020, closer to 20% of people chose gold plans. Now, closer to 50% of new buyers are going for the gold levels.

Free help is available for advice on choosing the best plan for you.

Assistance is available via the state-run exchange Pennie. To get help from a representative of Pennie, the state-run exchange, call 1-844-844-8040 or go to Pennie.com.

Both Highmark and UPMC have customer service workers to assist well as insurance stores and kiosks around the region. Reach Highmark Inc. sales representatives at 1-888-714-3798. Reach UPMC Health Plan at 1-877-563-0292.

Natasha Lindstrom is a Tribune-Review staff writer. You can contact Natasha at 412-380-8514, [email protected] or via Twitter .

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