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Should you enroll in marketplace health plans for 2017?
Editor's note: This is the second in a three-part series on the future of the Affordable Care Act in light of Republicans' pledge to dismantle President Barack Obama's signature health care law when they take control of both Congress and the White House next year.
Should you enroll in 2017 health insurance plans on the federal marketplace?
That's the post-election question.
Open enrollment for new and existing users of the marketplace is well on its way, even though a repeal or replacement of the Affordable Care Act is expected in 2017 — when Republicans will control Congress and the White House for the first time since before the health care overhaul became law in 2010.
Given President-elect Donald Trump's desire to end Obamacare, some might be wondering if there is a future for the federal health insurance marketplaces.
The answer is yes, according to state officials.
“While newly elected officials in Washington have stated they may repeal the Affordable Care Act in the future, there is currently no plan in place to alter our existing health care system,” said Pennsylvania Department of Insurance Commissioner Teresa Miller in a news release. “Though potential changes may be coming, enrolling now will help ensure the health of you and your family is protected in the short and long term.”
At least for now, Pennsylvania is moving ahead and encourages 2017 open enrollment signups. Coverage is available through Healthcare.gov through Jan. 31 for 2017, with the Dec. 15 deadline just a week away for coverage starting Jan. 1. Private insurance may also be purchased outside the federal marketplace, but those plans are not eligible for money-saving tax subsidies. Subsidies offset the cost of premiums for anyone making less than 400 percent of the federal poverty rate.
Spokeswoman Ali Fogarty said the Department of Insurance is "definitely pushing the message" that Pennsylvanians should get covered now as the new administration doesn't come in until 2017 plans will be already in effect. Being without coverage can be costly if a medical issue arises while uninsured, and there are still federal income-tax penalties for not carrying health insurance in 2017.
The department has released a tool in partnership with the Consumers' Checkbook website that compares the cost of ACA-compliant plans available on and off the exchange. While Healthcare.gov focuses on the monthly cost of having insurance, the new tool goes beyond monthly premiums and compares copays, deductibles and coverage.
”All we can focus on is what’s currently in front of us and taking care of their health for the time being," Fogarty said. "Unfortunately it’s hard to speculate on the future, but the importance of health insurance is to make sure you’re covered in the present.”
Navigating the marketplace: At Family First Health, certified application counselor Tammy Wampler is part of a two-person team that helps consumers navigate open enrollment. Mostly, the office gets phone calls to set up in-person appointments — about five per counselor each weekday. Occasionally, people walk in for help and are directed to make an appointment.
Wampler said she expects she and her co-counselor Arlene Feliciano to help about 300 people sign up for health insurance by the end of enrollment, but with just two people and appointments that can take more than an hour, the counselors are stretched thin.
Wampler and Feliciano preview what’s available on the exchange and help clients make a decision and fill out the required application.
In York, what's available is only four plans from Geisinger Health and Capital Blue Cross. Highmark announced it would not sell plans to Yorkers on the marketplace in October, citing sicker, costlier enrollees in the past. Aetna and United HealthCare pulled out of Pennsylvania earlier in the year for similar reasons.
”Most of them have gotten a letter saying the insurance company they had last year is no longer going to be in the 2017 selection of insurances and that they need to go online to switch or they will have a comparable one chosen for them,” Wampler said.
The lack of competition, among other problems shared by insurers, has led to on-exchange premiums in Pennsylvania going up 32 percent on average for 2017, with some plans in York County increasing by more than 40 percent. Nationwide, premiums are expected to go up about 25 percent.
Still, Wampler and the Department of Health and Human Services say tax subsidies offered by the federal government are available to offset much of that initial sticker price. Many clients, she said, will see their premiums go up just $10 a month after qualifying for subsidies.
Signing up: If the ACA is repealed, the Congressional Budget Office estimates about 24 million additional American adults would be uninsured between 2021 to 2025, 14 million fewer would be enrolled in Medicaid, and 18 million fewer would have coverage purchased directly from insurers. That means more Pennsylvanians are expected to join the ranks of about 775,000 residents who currently go without coverage or frequent free and income-based health clinics for their primary care.
By March 2016, about 412,000 Pennsylvanians enrolled in a marketplace plan and paid their first month's premium. According to the Centers for Medicare and Medicaid Services, 102,110 Pennsylvanians have selected a plan using the HealthCare.gov platform. That's about a quarter of the number of Pennsylvanians who signed up for plans on the federal marketplace last year, although many more are expected to sign up in the last few days of open enrollment.
Enrollment assistance is available through Family First Health’s George Street, Hannah Penn and Hanover centers with an appointment and at East Side Health Center and Memorial Hospital.
The cost of health insurance
Premiums: Usually paid monthly, a premium is the up-front cost of health care paid to insurance companies in exchange for their reimbursements to medical facilities and physicians.
Deductible: How much you have to pay out-of-pocket, other than for preventative care, before your plan starts paying its share.
Co-payment: What you pay for a covered health care service after reaching your deductible. Plans with lower monthly premiums tend to have higher co-payments. Plans with higher premiums tend to have lower co-payments.