Premiums up as Obamacare open enrollment starts

Nov. 01--When the Affordable Care Act's third open enrollment starts Sunday, many Lehigh Valley participants will have to pick new insurance plans.

That's because one-third of last year's 62 plans, including more than a dozen from Highmark Blue Shield, will soon cease to exist as the insurance industry moves toward coverage that shifts costs to consumers in the form of higher deductibles, co-pays and other out-of-pocket expenses.

For millions of Americans, open enrollment is the time to go online to switch insurance plans or sign up for coverage for the first time. Those who switch might be able to save money. And those who sign up can avoid costly penalties.

Throughout much of the country, rates are going up. In the 37 states, including Pennsylvania, where the federal government runs the online insurance marketplace, premiums next year will increase an average of 7.5 percent for the second-lowest-cost silver plan, according to an analysis by the U.S. Department of Health and Human Services. (Plans are rated by quality of coverage as bronze, silver, gold or platinum.)

In the nine insurance regions of Pennsylvania, where 473,000 residents receive coverage through the federal marketplace, the price of the second-lowest-cost silver plan will rise even more -- 11 percent on average, HHS said.

For the Lehigh Valley, that translates to an extra $52 expense -- though for lower-income enrollees the higher premiums will be offset by corresponding higher subsidies since the Internal Revenue Service uses the second-lowest-cost silver plan as its so-called benchmark to calculate tax credits.

"So no matter what your income is, you should be able to find a plan," said Antoinette Kraus, director of the nonprofit Pennsylvania Health Access Network in Philadelphia.

Eight insurance carriers -- the same number as last year -- are competing for customers in the insurance region that encompasses the Lehigh Valley, according to Kraus. However, the carriers are offering a total of 41 plans for 2016, a sizable decrease from the 62 plans available for 2015.

Leilyn Perri, spokesman for Pittsburgh-based Highmark, said his company reduced the number of plans it is offering in the region to six, down from 19 last year, "to simplify things for our members," and so that rates hikes "reflect what it costs to administer our health plans."

"A significant portion of our ACA enrollment was new to Highmark," he explained. "Our ACA members have been sicker than anticipated."

The open enrollment period will run through the end of January. Current policyholders who don't switch plans by Dec. 15 will automatically be re-enrolled under their existing insurance contracts starting Jan 1, provided their plans still exist.

Such a passive approach, however, could be costly, according to health law experts. They're urging people to explore options since the marketplace includes so many new plans, and also because the rates and other terms of some existing plans have changed.

Take, for example, one of the most popular plans in the Lehigh Valley from Capital BlueCross -- its platinum Healthy Benefits PPO plan. The monthly premium for a 40-year-old nonsmoker will go up 14 percent, to $549 a month, in 2016 from $482 in 2015. The co-pay to see a primary care physician, meanwhile, will remain the same, $10, as will the $6 co-pay for generic prescription drugs.

After tax credits, nearly eight in 10 returning marketplace consumers will be able to buy a plan with premiums under $100 month, according to HHS.

"If consumers come back to the marketplace and shop, they may be able to find a plan that saves them money and meets their health needs," Kevin Counihan, CEO of the Health Insurance Marketplaces, said in a news release. "Last year, over half of re-enrolling consumers on HealthCare.gov shopped, and half of those who shopped selected a new plan."

Meanwhile, people who are eligible for financial assistance but still don't get insurance face increasing penalties. Some of those without it in 2014 were forced to forfeit $95 -- or 1 percent of their income, depending on which was higher -- from tax refunds filed in the spring.

The cost will go up to $325, or 2 percent of income, for the 2015 tax year, and to $695, or 2.5 percent of income, for the 2016 tax year. (Deductions for uninsured children, which are half those of adults, can result in even larger penalties for families.)

Before the ACA, many people who wanted insurance had limited options because carriers could reject them or charge them higher rates for pre-existing conditions. But by end of the 2015 enrollment period that ended in February, more than 11.4 million consumers nationwide got insurance through either the federal marketplace or state-based exchanges, according to HHS. Millions of others have been covered through an ACA-mandated Medicaid expansion. Additionally, many young adults have been able to remain on their parents' insurance since the law also raised the age limit for parental coverage.

The reconfigured HealthCare.gov website went live on Sunday, giving users an advance look at insurance policies and prices before the start of open enrollment. The site has been revised to include new, user-friendly features, such as streamlined navigation, simplified re-enrollment and a calculator that gives cost estimates based on the amount of medical services consumers expect to use under different health plans.

"Open enrollment starts Sunday, and new and returning customers will find quality health coverage at prices that fit their budgets," HHS Secretary Sylvia Burwell said in a news release Friday

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SIGNUP HELP

"Navigators" help people sign up for health insurance through healthcare.gov. To find a navigator near you, contact the statewide help line: 877.570.3642 or [email protected].

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