Even as the 10-year anniversary of President Barack Obama’s March 23, 2010, signing of the Affordable Care Act approaches, many consumers still struggle to understand what the law can do for them, says Daniel Murphy of locally owned Hummingbird Insurance.
“We talk to people literally every single day who say that they don’t have health care,” Murphy notes, adding that many local residents who work in the service industry or part time believe the coverage would be beyond their means. “They have no idea that they would be eligible for zero-dollar, $5, $10 health insurance that would be dynamite,” he says.
With the Sunday, Dec. 15, open enrollment deadline for 2020 looming, now is the time to explore coverage, say Murphy and others involved in providing free, unbiased information about options available to consumers. Rates are the same whether someone signs up online, through a licensed insurance agent or through a health care navigator working with a nonprofit.
According to Josh Williams, manager of the Asheville Blue Cross and Blue Shield of North Carolina Store, one benefit of a maturing ACA market is lower premiums. According to an Aug. 21 press release from Blue Cross and Blue Shield of North Carolina — the only health insurance marketplace provider offering policies in Western North Carolina — the company lowered its individual plan rates an average of 5.5% across the state. For residents of WNC, premiums for 2020 individual plans will drop an average of 3%.
“It’s taken some time to get here,” Williams says, noting that premiums have increased in previous years. “This year, we’re thinking that the carriers understand the claims and they understand the population they’re insuring, and so now we’re just not seeing the big ups and downs.”
“The first year or two, we saw a whole lot of folks who had been without insurance for 10 years or more, so they got insurance for the first time, and they went to the doctor and they found out everything that was wrong with them,” adds Suzanne Wisnoski, who works as the assistant manager at the store. “For the first couple of years, we saw significant rate increases because nobody had any concept of what kind of health issues these folks were going to be dealing with. It’s been long enough now where those folks are now stabilized with treatment at the doctor’s office, and there aren’t as many of those shocking claims.”
Attorney Jaclyn Kiger, chief operations officer at Pisgah Legal Services, says that while the individual mandate that required taxpayers to purchase health insurance or face a penalty was repealed by the Trump administration last year, that move likely had no impact on premium rates or the number of people enrolling in ACA plans.
“What we hear from people is that what is really motivating them is the need for health care coverage, the desire to have access to care and also the financial protection in the event of a catastrophic medical emergency,” says Kiger.
Blue Select plans to leave market
Despite the market’s relative stability, residents in WNC may see a change in the plans that are offered by Blue Cross Blue Shield. Murphy says that BCBS’s Blue Select plans, the company’s most popular option, will be replaced this year by Blue Advantage, which offers a slightly higher level of benefits to consumers. He adds that those who currently are enrolled in the Blue Select plan will be automatically moved to the company’s new plan unless they work with an insurance agent to change their selection.
“Blue Cross will just assign a new plan to you if the plan you’re on is going away,” Murphy says, explaining that the “auto-mapping” process is based on a computer algorithm. Because people’s needs, subsidy levels and other factors may change from year to year, he recommends talking with an agent or counselor to fully understand the options and benefits of different selections.
Kiger adds that even small changes in income or family size can make a dramatic difference in the cost of health insurance premiums each month.
“I really want to emphasize that it’s really important to go back and update your financial information, even if you feel like nothing has changed,” Kiger says. “Even if you’re just going to auto-reenroll, updating your income is one of the single most important things to do as a part of this process because it is a projection of income for the full year of 2020. It is definitely worth the time to come back in, look at all your options and make sure your income is updated, because it can really make a big difference.”
Short-term plans may cover ACA shortfalls
While Blue Cross and Blue Shield is the only insurance provider in WNC that offers ACA-compliant plans, Hummingbird Insurance owner Geoffrey Ferland says that alternative plans are available to those who don’t qualify for subsidies or don’t feel a need for the comprehensive level of coverage required in ACA plans. The new plans can provide more customizable options for consumers, with some plans including preventive care services for the first time, Ferland says.
“[Insurance companies are] beginning to make efforts to create off-market insurance that functions and feels a lot more like Obamacare insurance,” Ferland says.
Off-market plans may also be an option for those affected by the “family glitch.” The trouble arises, Ferland explains, when an employee is eligible for an affordable employer-sponsored plan. Those affordability calculations, however, don’t factor in the costs of covering other family members. Once those costs are included, the overall price tag often exceeds what families can afford to pay, leaving many families unable to access either ACA subsidies or sponsored plans.
While alternative plans may work for some consumers experiencing the glitch or those who don’t qualify for subsidies, Ferland emphasizes that alternative plans are not ACA-compliant and don’t provide comprehensive coverage for substance abuse, pregnancy, mental health or preexisting conditions.
Coverage for preexisting conditions remains one of the most important aspects of the ACA-compliant plans, Kiger says. She notes that consumers may not realize that some common health conditions, such as asthma, fall into the category of preexisting conditions and may not be covered by off-market plans.
“With an ACA-compliant plan, you are getting the added protection of not being charged more or denied coverage because of your health condition or any preexisting conditions,” Kiger says. “Most people have them. I think I had three or four when I was looking at the laws and the way that they were applied.”
Who: Pisgah Legal Services’ Last-Chance Enrollment event
When: 9 a.m.-5 p.m. on Saturday, Dec. 14
Where: Grace Covenant Presbyterian Church at 789 Merrimon Ave.
Pisgah Legal Services 828-253-0406 www.pisgahlegal.org