Obamacare marketplace survives but Virginia premium rates are increasing by double digits

Sept. 30--But 2018 premium rates could take their breath away again, at least for a small percentage of enrollees on the individual market exchange.

The deadline for insurers to submit plans and rate changes on the Affordable Care Act insurance exchange -- what many call Obamacare -- was Wednesday, and the news from the state's insurance commissioner is sobering: Fewer choices and higher premiums.

Optima Health, the only insurer on the individual exchange in this area, will have an average increase in its individual health insurance plans of 81 percent, with an average monthly premium of $889.78.

Carriers throughout the state increased their rates by double digits because of market uncertainty, the reduction or withdrawal of other insurers and the lack of a guarantee from the federal government of subsidies for people with moderate incomes.

Anthem will be covering the nearby areas of the Eastern Shore and Southampton County and submitted a 54 percent average premium increase, with an average premium of $662.71.

Before your blood pressure goes up too much, consider this: The vast majority of ACA enrollees -- about 84 percent nationally -- qualify for a premium subsidy, according to the Kaiser Family Foundation. In Virginia, 83 percent qualify for a tax credit or a subsidy.

Optima officials say that 70 percent of their current ACA enrollees qualify for subsidies, which are payments to moderate-income enrollees to help them afford deductibles and out-of-pocket costs. Those enrollees will see their premiums increase by 1.5 percent, or about $4 a month, according to Optima spokeswoman Kelsea Smith.

Another thing to remember is that the ACA marketplace enrollees make up a small percentage of the overall insurance market in Virginia, with the larger chunk of people covered by employer-sponsored insurance, Medicare and Medicaid.

Instability of the ACA market is due to many factors, including Aetna and UnitedHealthcare pulling out of the Virginia market. Anthem reduced its coverage area, initially pulling out of all but a handful of localities, but then agreeing to cover so-called "bare counties" for a total of 68 localities.

Optima Health also curtailed its coverage area, focusing on about 30 localities where its affiliate, Sentara Healthcare, has facilities. In Hampton Roads, Optima Health is the only game in town as far as the ACA individual exchange goes.

People in the region who purchased an Anthem plan on the ACA exchange in the past will now have to start from scratch using information that will be available online later in October at www.healthcare.gov.

I've had several people call to inquire about what kind of changes in network to expect.

Smith said that Optima Health has a number of plans available on the exchange. Some are large networks that include a number of different health care provider systems, while others have a narrow network. Consumers will need to weigh costs against wider access to health care providers.

The enrollment period for 2018 insurance runs from this Nov. 1 through Dec. 15, which is the shortest it's ever been. Federal health officials have announced it will shut down the website for maintenance from 12 a.m. to 12 p.m. every Sunday during open enrollment except for Dec. 10.

Insurance counselors advise keeping a close eye on any mailings from current insurers and from the federal marketplace. These letters will tell them if they are being "auto-renewed" into the same plan or shifted to another plan with a different company.

The first premium payment for 2018 coverage must be made by Dec. 31, 2017.

The Medical Society of Virginia has provided guides on its website for patients and doctors to help with an enrollment process that's likely to be turbulent. Advice for patients includes checking to see whether your current health care providers will still be within network, and also checking prescription coverage.

The Virginia Beach health department will be conducting three ACA information sessions from 10 a.m. to 2 p.m. on Nov. 18 and Dec. 9 and from 4 p.m. to 7 p.m. on Dec. 13 at the Meyera Oberndorf Central Library, located at 4100 Virginia Beach Blvd. in Virginia Beach.

People should bring their Social Security number, pay stubs, W-2 forms or a tax return and the names and addresses of employers.

Jill Hanken from the Virginia Poverty Law Center, which runs the Enroll Virginia organization, said there will be two navigators in Hampton Roads to help enroll people. You can sign up for help through the organization's website at www.enrollva.org, email them at [email protected] or call their toll-free hotline at (888) 392-5132.

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