N.M. sees higher number of early sign-ups at healthcare.gov

Dec. 03--More than halfway through the period to enroll in a government-subsidized individual health insurance plan in 2018, more New Mexicans have signed up early for the plans than in previous years -- but that doesn't mean more people will end up with coverage.

The deadline for enrolling in individual plans on the healthcare.gov platform is Dec. 15, a sign-up period that is four weeks shorter than in years past. Since the Nov. 1 opening of the portal, some 15,440 people have chosen a health plan in New Mexico, up from 12,000 enrollees in the same four weeks in 2016 and 10,284 in 2015.

The healthcare.gov site is managed by the U.S. Health and Human Services Department. Self-employed workers and others who aren't covered by group insurance at their workplace can find coverage on the site if they qualify for federal subsidies or tax credits to offset premium costs.

Those with an income that falls above the threshold to qualify for the aid can go directly to individual insurers or other websites.

Workers enrolled in group health plans through their employers have an entirely different sign-up process, as do Medicare and Medicaid patients.

The individual health market has been the most volatile in the government-subsidized market. The federal Affordable Care Act, which requires most people to have health insurance or to pay a fine when they file their tax returns, was in part designed to bring this largely uninsured population into the health care system with more competition and stability. The mandate for coverage was an attempt to broaden the insurance pool to better share costs between those who are healthy and those who need more care.

The mandate, as well as the expansion of the government Medicaid program for low-income people, has pushed the uninsured rate in the state to about 10 percent of the population, down from 20 percent before the law went into effect.

Republican President Donald Trump and many Republicans in Congress want to lift the mandate for the coming year so those who choose to go uninsured can do so without a tax penalty. As a result of that uncertainty, as well as the elimination of some federal funding, many individual insurance premium costs have increased by 30 percent.

But having insurance is still required under the federal law, and health advocates in the state are trying to send a message that there are just a few more weeks to find a plan that begins Jan. 1. Four insurers -- Molina, Health Connections, Christus Health Plan and Blue Cross Blue Shield of New Mexico -- sell New Mexico plans on the healthcare.gov exchange.

The state's largest health insurance provider, Presbyterian, is offering individual plans outside the exchange portal without subsidies.

Barry Hatfield, an independent Santa Fe insurance broker, said higher premiums also have meant larger subsidies for those who qualify -- generally families making under $29,000 a year.

"The people who qualify for subsidies are doing great, better than ever before," Hatfield said. But more middle-income families are being hit with large increases and have had to pare down their coverage or go without.

Albuquerque broker Peng Mak said those middle-income consumers are looking at other options for coverage, including plans that provide only catastrophic coverage for hospital care or lower-cost "bronze" plans, which have higher out-of-pocket expenses for care but lower premiums for those who stay healthy.

Meanwhile, the New Mexico Office of the Superintendent of Insurance is putting out its own information about low-cost plans.

Office spokesman Michael Worthen said as many as 50,000 New Mexicans are eligible for bronze-level plans with no monthly premiums or gold-level plans for under $250 per month. For example:

--An Albuquerque family of four earning $65,000 a year could obtain coverage for the whole family with no monthly fee under a bronze plan, $207 a month for a gold plan or $415 a month for a silver plan.

--A 28-year-old in Clovis earning $25,000 a year could obtain coverage with no monthly cost for a bronze plan, $56 a month for a gold plan or $125 a month for a silver plan.

Insurance Superintendent John Franchini is urging consumers who need coverage or want to compare plans to use his office's free online plan comparison tool at OSICompareHealthPlans.org. The tool has details on all plans that are certified in the state.

Other information is available from the website Bewellnm.com, including a list of registered brokers, hours and locations for free help centers, and a way to get information over the telephone.

Contact Bruce Krasnow at [email protected].

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