We know that since 2010, the Affordable Care Act has insured more than 12 million Americans. Some of those covered are very happy and others are not. Regardless of this scenario, 2017 brings in a new administration and changes are anticipated. So, what does that entail?
The recent challenges in the ACA marketplaces are not insurmountable. Policymakers at both the federal and state level have many options for improving the affordability of private health insurance, both in the marketplaces and in workplaces, as well as for promoting competition and consumer choice.
According to the U.S. Department of Health and Human Services, approximately 12.7 million Americans bought health insurance last year through federal and state marketplaces, with 7.5 million more eligible to participate. Another nine million Americans received insurance through the ACA’s Medicaid expansion in 31 states.
The increased costs for ACA plans have received a lot of coverage. According to HHS, the premium for the second-cheapest Silver plan on the federal marketplace in the states for which data was available is up 22 percent over 2016. A recent analysis found that premium changes for that same Silver plan (based on a 40-year-old nonsmoker) ranged from a decrease of two percent in Ohio to an increase of 145 percent in Arizona.
But the statistics may not be as meaningful as they seem. About 84 percent of ACA customers receive subsidies, which means their out-of-pocket costs will not rise that much, if at all. HHS reported that 63 percent of those using the federal marketplace could get a Silver plan for $100 or less per month.
Plus, the statistics are averages, so you may be able to avoid higher costs by changing plans. Costs also vary by geography and age, so that a 60-year-old may pay more than twice as much as a 30-year-old.
Open enrollment began on Nov. 1, 2016 for federal and state health care exchanges. This provided subsidies for anyone making up to 400 percent of the poverty level – $47,520 for a single person or $97,200 for a family of four or $163,560 for a family of eight. Those with incomes below 200 percent of the poverty level are eligible for Silver plans with lower deductibles and co-pays.
High-deductible plans remain a part of the marketplace, with a maximum deductible of $7,150 for an individual or $14,300 for a family in 2017. These figures are also the maximum out-of-pocket costs.
A new kind of plan offered in many areas, called a "Simple Choice" plan, enables consumers to receive services such as doctor visits and some drugs for a co-pay before meeting deductibles.
Carriers are also nervous. Consumers must choose from fewer insurance providers.
- Aetna and United HealthCare pulled out of the federal exchange and some state exchanges.
- The Kaiser Family Foundation found the number of insurers in the federal exchange in 2017 will range from one in Alabama, Alaska, Oklahoma, South Carolina and Wyoming and up to 15 in Wisconsin.
Most insurers however, still offer multiple plans.
It is anticipated (but remains uncertain) that communities will have 30 plans to choose from, but consumers must know that health care is not a universal experience everywhere … it’s local and depends on where you live.
Consumers should be aware that if their current insurance plan were canceled, the marketplace will automatically enroll them in a new plan. Even if their plan is still offered, key elements, including providers, co-pays and lists of covered drugs, very likely change. That makes it essential to review choices every year.
If You Are Enrolling in the ACA, Consider:
- Call your doctors directly to find out if they accept the plan you are considering. Online directories are often outdated, and the ACA marketplace feature that lets you add doctors and hospitals to your search may not be accurate.
- Since many companies change how drugs are covered from year to year, or even during the year be sure to find out the cost for the drugs you take regularly, and even call the company to verify