The 122,000-plus Louisiana consumers who get health coverage through the Affordable Care Act's federal online marketplace will have less time to find a 2018 plan and a wealth of confusion to work through.
Enrollment on Healthcare.gov begins Wednesday and ends Dec. 15 for what are commonly referred to as Obamacare plans, just half the time consumers had to pick a plan a year ago. In addition to compressing the enrollment period, the Trump administration cut the funding for advertising and outreach efforts to promote enrollment efforts.
"Forty-five days is not going to be enough, but CMS (the Centers for Medicare & Medicaid Services) says the 45 days is needed to stabilize the market," said B. Ronnell Nolan, president and chief executive officer of Health Agents for America. "So we're just doing our best to see how many people we can see in a 24-hour period, seven days a week for 45 days."
Blue Cross and Blue Shield of Louisiana and Vantage Health Plan are the only Louisiana insurers offering Obamacare health plans through healthcare.gov.
The state Insurance Department recommends that consumers closely review their options and make sure to check the doctors and hospitals in a plan's network. Health plans can change from year to year, so staying with the same plan from a year ago doesn't guarantee a consumer will have the same benefits.
Brian Burton, director of Southwest Louisiana Health Education Center, said consumers face two major areas of confusion created by executive orders from President Donald Trump.
The first mistakenly created the impression that people are no longer required by the federal government to have health insurance — whether that be through Obamacare or other traditional plans. Those who don't have mandated health insurance will realize the problem when they do their 2017 taxes — sometime between Jan. 31 and April 15 — and are asked on tax forms about coverage, Burton said. By then, it will be too late to do anything about insurance for 2017 or 2018.
"So they're going to get hit with this fine twice because it is still the law," Burton said.
The 2017 penalty is the higher of 2.5 percent of household income or $695 per adult and $347.50 per child. The 2018 penalties have not been released.
The second executive order involved government payments to insurers for helping cover low-income customers' out-of-pocket costs. The president halted those payments, known as cost-sharing reductions.
"The consumer will still get those discounts. It's just that the insurance companies will no longer get reimbursed for them," Burton said.
State Insurance Commissioner Jim Donelon said cutting the payments will cost Blue Cross $10 million during the last three months of 2017, and it will cost Vantage $1 million. But the companies can absorb the losses without threatening their ability to pay claims.
Experts say the uncertainty surrounding the ACA will probably reduce enrollment for 2018. Consultants S&P Global estimates enrollment will fall by 7 percent to 13 percent nationally. Donelon said no one knows what the impact will be in Louisiana.
The state Department of Insurance encouraged the two insurers to assume there would be no cost-sharing reductions reimbursement in calculating the 2018 rates.
Donelon said Blue Cross and Vantage premiums will increase an average of 18.5 percent for individual plans in 2018.
Lost among the Affordable Care Act's successes, such as reducing the number of uninsured to …
Even though the 2018 rates increased, subsidies available to most consumers also increased to cover rising premiums, Burton said.
Blue Cross and Vantage concentrated the premium increase in their Silver plans, which cover 70 percent of costs. The cost-sharing reductions are only available to people buying Silver plans.
Blue Cross spokesman John Maginnis said the strategy minimizes the impact of rate increases on customers.
Maginnis noted that those in Silver plans with higher incomes who don’t qualify for cost-sharing reductions on out-of-pocket expenses or premium subsidies can move to a bronze or gold plan to potentially avoid higher costs.
The Commonwealth Fund, a private foundation whose goal is improving health care, said some of those consumers could avoid increased costs by buying a health plan outside the marketplace.
For consumers who qualify for Advance Premium Tax Credits, a monthly subsidy, there are some pretty good deals available, Burton said. A single person who makes $25,000 to $30,000 a year can find a plan and pay nothing in premiums, or close to nothing.
Ninety percent of the 122,700 Louisiana residents who enrolled in marketplace plans for 2017 received the tax credits while 58 percent got the cost-share reductions, according to CMS.
The Kaiser Family Foundation, a health-focused nonprofit, said some people whose incomes are 250 percent to 400 percent of the poverty level may be better off than before. Those people will receive larger amounts of tax credits and pay less than they would have for bronze plans, which cover 60 percent of costs, or gold plans, which cover 80 percent.
But the people who earn too much to qualify for the tax credits, those who make more than 400 percent of the federal poverty level, or $90,000 a year for a family of four, will really feel the pinch, Burton said. Another way to put it: The people who were already angry about their Obamacare premiums are going to be even angrier, he said.
For Margie Ohmer, there is no debate. The federal health care law helped save her life. It c…
Nolan said one of her clients, a woman in her early 50s, is looking at a 66 percent increase in premiums.