Passing on health insurance could still cost you. ACA open enrollment ends Dec. 15.

Nov. 12--Charleston -- While the tax penalty is gone, going without health insurance could still cost you.

At least for now, the Affordable Care Act is still law, and if you don't have insurance, you have until Dec. 15 to sign up for health insurance plans that meet the law's requirement to cover health problems related to pre-existing conditions.

In 2017, Republicans in Congress, who had the majority in both the Senate and U.S. House of Representatives at the time, voted to remove the tax penalty for not purchasing health insurance. That penalty was one component of the Affordable Care Act, which passed in 2010.

Meanwhile, a Texas judge is expected to rule soon on whether to strike down the rest of the law, including its requirements to allow people who make up to 138 percent of the federal poverty level to use Medicaid, a health insurance program for low-income people that used to mainly serve older people, people with children, and people with disabilities. About 157,000 West Virginians have gained coverage because of that provision, according to the West Virginia Department of Health and Human Resources.

West Virginia's Attorney General Patrick Morrisey is one of several state attorneys general seeking to dissolve the Affordable Care Act, sometimes referred to as Obamacare, in that lawsuit. But as of now, the law still exists, and provides tax credits to people who purchase health insurance on the exchange, also known as the marketplace, found at healthcare.gov.

Those plans are where you can find ACA-compliant policies that don't discriminate based on pre-existing conditions or gender, and where the government will pay part of your premium if you meet income guidelines. Those plans are also required to include "essential health benefits," such as preventative care, emergency care, maternity care, prescription drugs, substance use treatment and mental health care.

Open enrollment for people who want to purchase one of those plans began Nov. 1 and ends Dec. 15 for plans beginning Jan. 1, 2020.

According to Jeremy Smith, ACA Navigator program director for First Choice Services, those struggling continue to be a group of people who make too much for the tax credits offered through the exchange, but aren't offered coverage through their employer.

About 14 percent of marketplace enrollees in West Virginia fell into that group last year. Tax credits are available for those making up to 400 percent of the federal poverty level -- up to nearly $50,000 for a single person, $67,000 for a family of two, about $85,000 for a family of three, and $103,000 for a family of four.

"Most people have had the attitude of why would I pay that much per month with that high of a deductible when I can just put all that money in the bank and if something happens to me, I would rather try that," Smith said.

"If they're hospitalized for a few days, or if they're in a car wreck, they can run up thousands of dollars of medical bills just in a few days, so yeah, it's a little bit of a gamble for a lot of people, and they don't really know what to do that's going to be best for them and their family."

First Choice Services' Navigator program receives federal funding to help people who want help selecting and enrolling in a plan. So far this year, Smith said that similarly to last year, they've received many calls from people wondering if the Affordable Care Act still exists.

Plans offered on the exchange have increased rates each year. Ellen Potter, director of health policy at the Offices of the Insurance Commissioner, said this year, her office permitted a single-digit increase, noting that health care and prescription drug costs remain high.

The number of people who buy plans on the marketplace in West Virginia, meanwhile, continues to decline.

West Virginia previously received $600,000 in federal funding a year for promotion of the Affordable Care Act. Last year, the Trump administration cut that funding to $100,000, and one program that like FirstChoice, also offered help enrolling, lost its funding.

In 2017, the federal government also slashed the advertising budget for Affordable Care Act. In West Virginia, marketplace enrollment declined from 34,045 people in 2017, to 27,409 in 2018 and 22,599 in 2019. That's a decline of about 11,500 people.

First Choice workers used to travel frequently to community health fairs and other events to educate people on their options, Smith said. Now, their five-person team mainly accept calls in their office, and occasionally visits Beckley and Parkersburg. He said if they get enough requests for in-person, the library in Beckley allows them to use the conference room for one-on-one meetings.

They do now offer telehealth appointments by computer, he said, so that those enrolling can see the First Choice worker and each can see the other's screen.

Part of the decline could be explained by people enrolling in other health insurance programs instead. More than 7,000 people aged into Medicare, according to the Offices of the Insurance Commissioner.

But not all of the decline.

Medicaid and CHIP enrollment declined by more than 20,000 during that time period. And it can't be explained by economic improvements as well -- from 2017 to 2018, nearly 18,000 fewer West Virginians were covered by employer plans; 2019 figures were not yet available.

"They don't have to anymore," said Potter, "and they can't afford it, so they're not buying it."

The Trump administration, in 2018, also publicized the use of limited benefit plans, which may be cheaper but aren't required to offer the same essential health benefits.

Smith said many people also mistakenly use healthcare.com, instead of the official site, healthcare.gov, and end up receiving 10-20 calls a day from telemarketers selling those plans.

He said that while they have many repeat callers each year, he worries about those who don't know about their program and are misled by those telemarketers.

Those who'd like assistance can call First Choice at 304-356-5834 or toll-free at 844-WV-Cares.

Potter, of the Offices of the Insurance Commissioner, noted that those plans aren't required to cover pre-existing conditions. They've talked to several people who ended up with thousands of dollars in unpaid medical bills, she said.

"People don't understand what they're buying is our biggest concern," she said. "We hate for it to be publicized because people might buy it because it's cheaper, but that's not the way to look at insurance."

She added that those who are misled by those telemarketers or others selling insurance plans can contact the consumer services division of her office at 888-879-9842 for assistance.

West Virginia has two health insurance companies that sell plans on the exchange, Highmark West Virginia and CareSource. CareSource, which entered the marketplace in 2016 in West Virginia serving only 15 counties, now serves most of the state, excluding the Eastern Panhandle region, Smith said.

While CareSource plans are often cheaper, that insurance company also requires patients to select from a more limited network of healthcare providers.

"For example, in the Charleston area, CAMC doesn't accept CareSource," Smith said, referring to Charleston Area Medical Center. "A lot of people that I talk to have to make the decision of 'Do I want to go with the cheaper policy or do I want to make sure that my existing doctors are in network?' "

Potter also noted that one other health insurance company, The Health Plan, offers a plan that does meet the Affordable Care Act requirement to cover pre-existing conditions, but isn't on the health insurance exchange found at healthcare.gov, and doesn't offer the tax credits. She suggested that those who know they aren't eligible for those tax credits could contact The Health Plan for more information.

Email: [email protected] and follow on Twitter @3littleredbones

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