Volusia, Flagler consumers find deeper discounts on Obamacare health insurance

News-Journal (Daytona Beach, FL)

Nov. 08--DELAND -- Cindy Carter didn't know what to expect when it came time to enroll for Affordable Care Act insurance this year. After hearing the president decry Obamacare as a failure and watching congress go through an endless parade of repeal and replace options, Carter, a full-time caregiver who lives in Deltona, feared the worst.

Lynn Hoganson, a local navigator who helps people sign up for government health programs, assured Carter they'd find something. Some of Hogansen's regular clients had been calling her, worried about their fate. Notices from insurers said premiums would shoot up by double-digit percents.

"Wait until you sit down (with me)," Hogansen would say before the Nov. 1 start of the sign-up period, which runs through Dec. 15. "It's not going to be as bad as you think."

With about $12,000 in yearly income from an IRA, Carter, 57, is a shoo-in for a subsidy to help cover the cost of her monthly premium payment. Carter chose a silver plan and learned that she would pay $20 per month -- $5 less than she has been paying. And that was with no deductible.

In fact, everything had gone down: doctor's visits and other out-of-pocket costs. A lower tier plan would have been free.

"Holy (expletive)," Carter said, surprised.

"That's why I tell people don't panic," Hogansen said.

It's one of the mysteries of the insurance marketplace this year. How exactly were insurance companies able to stay on the exchange -- without one of two key subsidies -- and in some cases offer deeper discounts?

Like most things in insurance, the explanation is complicated. Simply put: The one subsidy that's left is paying for the one that President Donald Trump eliminated.

After Trump threatened to yank the cost sharing reduction, or CSR, subsidy that helps 5.9 million Americans pay for copays and deductibles, insurers were warned to submit new rates for silver plans as if it had already happened.

A silver plan is the most popular option for people who receive either subsidy. Those new policies were priced to be much more expensive than they would have been without the subsidy. The Congressional Budget Office estimated that the move by Trump will actually cost the federal government more money in the long run, but last month he followed through on his threat.

Yet before Trump killed the subsidies for deductibles, those costs were shifted over to the premium payment, which is the part of the insurance the federal government still underwrites.

Close observers of the Affordable Care Act call it the "Silver switcharoo."

"They figured out a way to prevent any enrollees from having to pay the CSR surcharge (in theory), with subsidized actually coming out ahead," wrote the health care analyst Charles Gaba, who authors the blog ACASignups.net.

Not every state pulled it off. There have been a jumble of different strategies, but Florida's, according to Gaba, is considered one of the best.

"It should work especially well in Florida since such a high (percentage) of enrollees receive (subsidies for copays) to begin with," he said.

For consumers, selection will be essential to maneuvering around the uncertainty in the government-run insurance program. This year prices rose again and people without a subsidy will be challenged to find the right plan. But 94 percent of the more than 1.4 million Floridians who bought coverage on the exchange this year received a premium discount, according to the Department of Health and Human Services.

Not quite eligible for Medicare yet, David Belcher was able to see the same kind of savings as Carter for the same silver-level insurance plan with Florida Health Care Plans, a local HMO. Belcher, 63, of DeLand, had an income that qualified him for a $982 premium tax credit.

His monthly premium payment also decreased by $5, so he'll pay $36 every month in 2018. Belcher migrated to the exchange after he stopped working as a middle manager in a large home improvement store two and a half years ago. He has "no complaints" about the coverage.

"I only go to see them three times a year because I'm relatively healthy," Belcher said.

Belcher understands how many people could become confused. The mixed messages in the media haven't made it any easier.

"This is a big deal for a lot of people," Belcher said, adding that the confusion may be from listening to "too much fake news."

Recently transplanted from Maryland, Susan Maenner, 56, of Port Orange, enrolled in exchange coverage for the first time last week. Maenner retired from her job at a Baltimore airport in June. Although she describes herself as "very healthy," Maenner knew she would need health coverage.

With the help of another navigator, she found a plan that was $153 per month after a $639 premium subsidy was applied.

"I could have even got a plan for less, but I wanted something that would cover specifically ER, labs and X-Rays," Maenner said. "Something that would be a little better."

___

Visit The News-Journal, Daytona Beach, Fla. at www.news-journalonline.com

Distributed by Tribune Content Agency, LLC.