Open enrollment begins for health insurance

Nov. 06--The time has arrived for individuals seeking health insurance through the Affordable Care Act to purchase plans for 2018, while health care advocates worry that political noise and a general lack of support from the federal government this year could have people missing out.

Organizations like the Missouri Foundation for Health are doing their best to see that doesn't happen. Along with Cover Missouri, a group of about 300 organizations across the state, the nonprofit Foundation is doing its part to get information and assistance to Missourians.

"It's been in the news a lot and there is a lot of confusion out there," said Nancy Kelley, expanding coverage program director for the Missouri Foundation for Health.

Several efforts have been made to repeal and/or replace "Obamacare," but they have failed. President Donald Trump has ended a portion of funding to insurance companies that had helped keep health insurance costs down, the federal government is spending about 10 percent of what it had previously on public relations and marketing efforts during the enrollment period, and funding has been reduced for what are called navigators, people who provided free enrollment assistance to Americans, providing less help overall.

But, Kelley said, there is still a network of navigators and certified application counselors out there who stand ready to help. And that's good news for the more than 3,000 individuals combined in Adair, Knox, Linn, Macon, Putnam, Schuyler, Scotland and Sullivan counties who purchased plans through the Healthcare.gov Marketplace last year.

The bottom line

Much has been made of the soaring costs of premiums for plans in the Marketplace, with many areas in Missouri seeing costs rising nearly 50 percent.

Few users, however, actually feel the full brunt of that increase thanks to premium tax credits. The maximum tax credit is based upon a formula that brings the cost of a silver level plan's monthly premium to $201. This year, the max credit is $489 in the northeast Missouri region.

According to a study by the Saint Louis University School of Law Center for Health Law Studies, almost 90 percent of Missourians who purchase Marketplace plans qualify for premium tax credits, which is based on their annual income.

The figure is even higher in Adair and surrounding counties. According to data from the Centers for Medicare & Medicaid Services (CMS), 93 percent of Marketplace shoppers in Adair, Linn, Macon, Scotland and Sullivan counties qualified for premium tax credits last year, with the average monthly credit in the group $549.

The tax credit can be applied to the monthly premium of any Marketplace plan. For example, a 40-year-old non-smoker with an annual income of $30,000 in Kirksville would qualify for the full $489 monthly tax credit this year. That credit could be applied to a low-level bronze plan (which carries a $5,450 deductible) to bring the monthly premium to just $100.66; the lowest silver plan (which carries a $3,500 deductible) to bring the monthly premium to $173.96; or to a gold plan (which carries a $1,250 deductible) to bring the monthly premium to $508.98.

CMS data shows northeast Missouri consumers almost exclusively select bronze and silver plans.

Cost jump causes

There are a number of reasons for the increase in plan costs, many of which are self-inflicted.

Dylan Kriegshauser, a third-year student in Saint Louis University's health law program and a co-author of the university's study, said they identified two key factors. One is the enrollment period, which the federal government slashed in half to just 45 days this year. That is expected to reduce the number of consumers.

"Insurance is the sharing of risk," Kriegshauser said. "This year's enrollment period is half as long. If fewer people sign up, there are less for sharing the risk, and it's more expensive for the folks bearing it."

Another is the Trump Administration's ceasing of sending cost-sharing reduction payments to insurance companies. In order to offset costs, insurance companies increased the prices of the silver plans to help pay for lower rates of those who qualify for premium tax credits.

The benefits of the cost-sharing reduction payments, however, remain in place. CSRs provide reductions in copays and deductibles on certain silver level plans.

"The good news is for the end consumer purchasing the plan that qualifies, they still qualify and still get them. The difference is the insurance companies aren't getting reimbursed," Kelley said.

PPO vs. EPO

In prior years, PPO, or Preferred Provider Plans, dominated Missouri's Healthcare.gov Marketplace. Of the 133 plans offered last year, all but 18 of them were PPO plans.

Designed with an "open network" of providers, PPO plans carry a list of preferred health care providers under which a higher percent of costs will be covered. Visiting a doctor not "in network" would still provide insurance coverage, but a larger share would be paid by the consumer.

In 2018, however, Missourians will find no PPO plans. All 90 plans offered statewide are EPOs, or Exclusive Provider Network plans, which typically only provide coverage if health care services are performed by an "in network" entity.

"You cannot go out of network. You have to use the doctors and facilities that are in your plan. If you go out of network it's 100 percent on you. There's no cost sharing or anything like that," Kelley said. "It doesn't necessarily mean it's a smaller network, but the network is the network and that's it."

Kelley said it's important for consumers to look beyond the "sticker price" on the healthcare.gov plans. Information is available that lists physicians, facilities and medications that the different plans cover.

Get started early

In addition to slashing the enrollment period in half, the federal government has also stated that healthcare.gov will have planned outages every Saturday starting at midnight until as late as noon Sunday. Visitors will be able to browse plans and information but not complete any enrollment steps during those times.

Kelley said people should seek help and plan to enroll early, as a deadline extension this year is unlikely and website traffic should only intensify as Dec. 15 draws closer.

Kelley encouraged those looking for help to call 1-800-466-3213, or visit findlocalhelp.covermissouri.org, to find local assistance and be able to set up appointments.

If attending an appointment for assistance, individuals should have a working email address, accurate personal income information and Social Security numbers for all members of their household listed on income tax documents.

The ACA remains the law and its insurance plans will remain in place through at least the end of 2018. Most of those who do not have health insurance either through a private insurer or the government will face a tax penalty.

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