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If you are among the more than 154,000 Ohioans who have already signed up for health care coverage through Ohio’s federally run insurance marketplace, you don’t need to take action because the government will automatically re-enroll you in your current plan.
But you might to at least peek at what is being offered.
As the second open-enrollment period for health insurance coverage under the Affordable Care Act kicked off Saturday, Ohio’s marketplace has a distinctly different look. Many health plans have changed and several new health insurers are offering coverage in the marketplace for the first time.
Even those who are happy with their current coverage are being encouraged to shop for a better deal in the marketplace.
“One of the problems with automatic renewal is that a lot of people just won’t think about renewal,” said Stacia Dawson, an ACA outreach and enrollment coordinator at Community Health Centers of Greater Dayton. “But they really should. Based on what I’ve seen, there are a number of new plans and monthly premiums seem to be significantly less.”
Dawson said enrollment assisters helped a local couple in their early 60s preview marketplace plans last week and the results were eye-popping.
“They were looking for coverage for a family of two with (annual) income of $30,000,” she said. “We found a ton of plans with zero monthly premiums. We looked at 17 plans before we found one with a premium that was a little over $100.”
The U.S. Department of Health and Human services allowed visitors to the HealthCare.gov website — the main portal for enrollment in Ohio and 35 other states — to view estimated marketplace premiums for sample plans before enrollment actually began. Consumers will have to fill out a Marketplace application to get actual plan prices.
Price shopping
Deductibles for marketplace plans, which are capped at just over $6,000 for individuals and $12,000 for families, appeared to be “slightly higher” for many plans, Dawson said. But most plans provide basic benefits, such as screenings, immunizations and other preventive care, before a policyholder is required to meet the deductible.
The most popular plans in the marketplace, designated as “silver” plans, are eligible for tax credit subsidies to lower deductibles and other out-of-pocket costs, including co-pays, Dawson said.
Marketplace customers also have the option of choosing plans with higher monthly premiums and lower deductibles, but most customers shop on price.
“Most people want to know what their premium is going to be,” Dawson said. “That’s the first thing they ask about.”
Gross marketplace premiums, on average, are projected to rise 12 percent in Ohio next year, based on data released by the Ohio Department of Insurance. But premiums will vary dramatically by insurer, and premium costs for many existing plans are likely to be much lower, said Jonathan Wu, chief analyst and founder of ValuePenguin.com, a health insurance price comparison website.
“A lot of the more expensive insurers are definitely lowering their rates,” Wu said. “They were charging so much that they basically didn’t attract many customers this year. That’s why we’re seeing the rates come down in 2015.”
Wu was referring to rates before premium subsidies, which are available to most marketplace enrollees.
More than 85 percent of Ohio enrollees qualified for federal tax credits to help cover the cost of their marketplace plans this year. The credits are available to most people with annual incomes up to four times the federal poverty level, or $46,680 for an individual or $95,400 for family of four this year.
“Subsidies are fixed, based purely on your income,” Wu said. “So if you have a $200 (a month) plan with a $90 subsidy, and you switch to a cheaper plan, you’re still getting the $90 subsidy. In some situations, the subsidies may be generous enough so you’ll end up paying nothing at all.”
Increased competition
Competition in the marketplace will put more pressure on health insurers to lower premium rates, advocates say. Nationwide, the number of insurers participating in state and federal marketplaces is up 26 percent over last year, according to the U.S. Department of Health and Human Services.
Ohio’s marketplace has grown from 12 to 16 insurers offering more than 200 health plans.
Wu said newcomers and existing plans will have to keep prices low to compete for customers with the lowest-cost providers, including Dayton-based CareSource, which signed up more than 30,000 new members in Ohio this year.
CareSource, which will expand its marketplace business into Indiana and Kentucky next year, said its Dayton-area customers will see their marketplace premiums decline by an average of 2.5 percent next year.
Enrollees in the company’s silver plans could reap even greater savings, based on sample plans from the company.
For example, a 25-year-old non-smoker who is paying a monthly premium of $204 for a CareSource Just4Me silver plan this year would pay $198 a month for the same coverage next year. Meanwhile, a 45-year-old non-smoker paying $293 a month for a sliver plan from CareSource this year would pay $285 next year.
In both cases, premiums would drop nearly 3 percent, before subsidies.
Statewide, CareSource said its marketplace premiums would increase, on average, by 2 percent.
That’s in line with a recent bi-partisan study from McKinsey Center for U.S. Health that found increased participation by private insurers in state and federal marketplaces would result in a median increase in premium prices of about 4 percent.
“However, the actual increase they pay could be less than half that amount, given that many people will have the option of switching to a lower price plan,” the study’s authors wrote.
Future clouded
A legal challenge could impact which states offer subsidies in the future. The U.S. Supreme Court recently announced that it will hear a case that argues the subsidies are illegal in the 34 states using the federal exchange because the federal exchange is not explicitly mentioned in the law.
A ruling for the plaintiffs could jeopardize subsidies for millions Americans buying coverage on the federally run marketplaces, including in Ohio.
Republican lawmakers, who take control of both houses of Congress next year, have also vowed for a repeal of the law.
The subsidies are in place for now, however, and advocates argue that the law’s clear intention was to make health care affordable for all Americans.
“That’s exactly why a number of courts have already dismissed these politically motivated challenges,” said Anne Filipic, president of the nonprofit Enroll America, which advocates for expanded health care coverage. “We’re confident the Supreme Court will do the same.”
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