That scary letter about Obamacare? Here’s what it means.

Oct. 26--Kayte Thomas received a letter from Blue Cross and Blue Shield of North Carolina in October that said her monthly health insurance premium is set to more than double from $208 a month to $585 a month.

The quoted $377-a-month hike startled Thomas, who lives in Morrisville and covers herself and three children on her Affordable Care Act plan. That's half the food budget for her family of five, she said.

"My first reaction was like panic," she said. "Where are we coming up with this money?"

What was not clear in the letter, Thomas said, was that she won't have to pay the full amount. The financial help she gets will climb, offsetting the increase.

Blue Cross said it is required by the federal government to mail out letters before open enrollment, but it has not yet been given updated subsidy information to include in the letters.

The lack of clarity is adding to the confusion over the the Affordable Care Act insurance marketplace, Thomas said.

Actions at the federal level have also made information about this year's open enrollment more confusing.

The Trump administration cut spending on advertising for open enrollment, which begins Nov. 1, by $90 million, and shortened open enrollment by six weeks, ending in North Carolina on Dec. 15.

Earlier this month, the administration cut about $7 billion in federal money paid to insurance companies to make out-of-pocket expenses on marketplace health plans more affordable for 300,000 N.C. residents.

"My anxiety wouldn't be so high around this if the constant attacks on health care didn't exist," Thomas said.

The letter from Blue Cross to Thomas stated that her monthly payment in 2017 has been $208.15, after $986 in financial help was applied to the full premium of $1,570.93.

Below that, a bold sentence reads: "Starting in January, your estimated monthly payment will be $584.93."

The letter goes on to explain that estimated payment includes only her current amount of financial help, later saying, "To find out how much financial help you qualify for in 2018 and your new premium amount, update your Marketplace application."

That wording was confusing and it was unclear to Thomas that she wouldn't have to pay the full $585, she said.

The letter could have proactively stated in simple terms that consumers should keep in mind that the projected premium increase does not include increases to the 2018 subsidy, Thomas said.

Or Blue Cross could have waited and sent the letters after that information was available and included it, she said.

Blue Cross uses the previous year's subsidy information because insurers are required by the federal government to notify members of their new premium amount prior to the start of open enrollment on Nov. 1, said Blue Cross spokesman Austin Vevurka in a statement.

Blue Cross also depends on Centers for Medicare & Medicaid Services to send updated subsidy information each year, which Blue Cross said on Tuesday, has not yet been.

To meet CMS's requirements that members be notified of their premium prior to open enrollment, Blue Cross uses the previous year's subsidy information.

"We are always looking for ways to work with CMS so that subsidy information is communicated to us as early as possible," Vevurka said.

A Charlotte attorney for health care access said that notices being sent out explain the cost listed is just an estimate and the actual cost will be available on the January 2018 bill.

"The good news is that when premiums go up, so does financial assistance," said Madison Hardee, of Charlotte Center for Legal Advocacy.

Blue Cross also said that the premium subsidy information is based off of the financial assistance consumers received in the previous year, adding that when premiums increase, so do premium subsidies.

"As a result, the out-of-pocket costs they see in their letter is not necessarily the out-of-pocket cost they will pay after their larger subsidy is applied," Vevurka said.

New health plan and premium information was made available on Wednesday at healthcare.gov.

The majority of N.C. residents with ACA plans get financial assistance.

Nine out of 10 North Carolina residents with ACA plans received financial help paying for their health insurance in 2017, Hardee said.

The Trump administration recently targeted one of the two subsidies available.

The federal subsidy, called a cost sharing reduction, pays insurance companies to reduce the cost of out-of-pocket expenses, including copays and deductibles for ACA plan participants.

Insurance providers still have to provide the discounts, so they will have to absorb the cost of losing that money. Insurers attributed the uncertainty over the subsidies as part of the reason for raising premiums for 2018 plans.

Insurance companies have also said that loss of money could make it more difficult for them to continue to offer insurance on the exchange in the future.

"If I could trust that our government was working to ensure everyone had real, affordable access to care, I wouldn't be so scared," Thomas said.

Another target of the Trump administration was cutting funding for navigator programs, which help people enroll in ACA plans.

For example, in South Carolina The Palmetto Project will get about $500,000 in federal grant money this year, down from about $1 million in previous years.

Initially that meant residents in York, Lancaster and Chester counties wouldn't have an on-site navigator to help residents enroll. However, the group was able to relocate a navigator to spend one day each week in York County for the open enrollment period, said Shelli Quenga, director of programs for the nonprofit, this week.

That's down from a navigator being available two or three days a week in previous years.

While North Carolina did not see as large of a cut with navigator funding as other states, "any cut is difficult," said Willona Stallings of NC Get Covered.

Affordable Care Act groups that help people enroll want to cut through the rhetoric about misconceptions including, whether there is another open enrollment and if the Affordable Care Act is still the law

That can be achieved by consumers talking about the difference the health plans have made in their lives, she said.

"It's powerful, it can make a huge difference," she said

Cassie Cope: 704-358-5926, @cassielcope

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