Virginians enrolled in the state’s Affordable Care Act-related individual health insurance plans need to check their status before the enrollment period ends Dec. 15 or they could end up paying hundreds of dollars more in monthly premiums than they anticipated, advocates say.
That’s despite letters sent from insurance companies in September and October stating that 2020 premiums were not expected to substantially rise and could even fall as low as zero dollars per month with financial aid.
“The letters presented a rosy picture in terms of premiums and prices for next year and a lot of people were expecting [premiums] to be a little less per month or even nothing. But that’s not happening,” said Jack Hanrahan, an ACA volunteer who works with the Jefferson Area Board for Aging and the Legal Aid Justice Center.
“Some of the people we’ve assisted expected to see premiums drop, but instead have seen them increase by $100 to $300 a month. For a family that’s getting by at or near the poverty level, that’s devastating. Anyone who was planning on letting their health insurance auto-enroll needs to check out the premiums they will be facing,” Hanrahan said.
After Dec. 15, there is no recourse to change a medical insurance policy unless a qualifying life event occurs. According to the insurance marketplace rules, anyone currently enrolled in health insurance through the exchange will automatically be re-enrolled in the same or a similar plan unless they select a different plan by the deadline.
“A 45-year-old woman making $25,000 would have paid about $81 a month last year, and this fall she received a letter indicating that cost would likely go down,” Hanrahan said. “But with the change in how the state board is determining subsidies, she would have found out that her last year’s policy will cost her $203 a month in 2020. That’s $1,500 a year. When you’re only making $25,000, that additional cost is not good news.”
There are an estimated 10,722 people in Central Virginia enrolled in Obamacare, according to Healthcare.gov. About 2,200 people so far have automatically re-enrolled so far this year, according to the website, and could be impacted by the change.
The area includes the city of Charlottesville and Albemarle, Greene, Nelson, Fluvanna, Louisa and Orange counties.
“It’s such a complicated landscape right now that it’s hard to understand what the impacts may be,” said Ian Dixon, of Charlottesville for Reasonable Health Insurance, an advocacy grouped formed in 2017 in response to big rate hikes in area health insurance premiums on the exchange.
“It’s always a good idea to review the plans each year,” Dixon said. “You can never be sure that the plan you had last year is the best option this year. Reach out to those who offer help because the complexity of the process is a feature of the process. It’s difficult for customers to be confident in what the plans are offering.”
The increase in 2020’s final premium costs was caused by a shift in how the Virginia Insurance Board determined tax credits and financial assistance applied to lower premium costs.
The plans are graded as gold, silver or bronze. Gold insurance plans pay more medical costs and have lower deductibles, but higher premiums. Silver plans are in between and bronze plans have the lowest monthly costs, but cover fewer medical costs and have higher deductibles.
In 2018, Optima was the only insurance provider in the area. Costs for plans skyrocketed with premiums for a family of four, without financial assistance, reaching more than $3,000 a month. Anthem joined the region’s marketplace last year and the competition drove prices down.
In 2020, Optima will offer limited network plans that restrict which hospitals and doctors may be used by a patient as a way to lower its premiums.
According to Optima, the limited plans exclude “most doctors and facilities in [the University of Virginia Health System].”
“If someone has a standing appointment with an oncology doctor at the University of Virginia and they sign up for a limited network plan, they could find that their doctor’s visit is not covered at all beginning in January,” Dixon said. “Our biggest fear is that people will not be aware that these plans are so restrictive.”
The limited network plans are available only in Albemarle, Greene, Fluvanna, Nelson and Rockingham counties and the cities of Charlottesville and Harrisonburg, according to Optima. Those patients would be served by Sentara Healthcare physicians and Sentara Martha Jefferson Hospital.
In addition to Sentara hospitals, other hospitals participating in the limited network plan include Virginia Commonwealth University in Richmond; Children’s Hospital of the King’s Daughters in Norfolk; Eastern Virginia Medical School in Norfolk; and Riverside Health System, based in Newport News, according to Optima.
The state insurance board normally bases tax credits and aid for ACA marketplace policies on the premiums of the second-lowest-cost silver plan. This year, that plan is Optima’s limited network plan.
Because the limited network plan is a lower cost option, it skewed the amount of financial aid lower, resulting in less assistance and, therefore, higher monthly premium costs for the larger network plans offered last year, advocates say.
The insurance board made its decision to go with the limited plan as a baseline in late October. Insurance companies are required to send out letters prior to the Nov. 1 opening of the enrollment period and were not aware of the state’s decision.
Hanrahan said the state board’s change in baseline plans has resulted in many people trading down from better coverage plans to those that provide less coverage and more out-of-pocket costs but lower monthly payments.
“Our concern is a lot of people are going to be stuck with higher premiums they cannot afford and are going to drop their insurance after struggling to pay them for a few months,” Hanrahan said.