Affordable Care Act Open Enrollment

From Arizona Republic 

Open enrollment for Affordable Care Act health insurance began this month with overall higher monthly costs, though enhanced federal subsidies are expected to offset some of the increases.

The program, commonly called “Obamacare,” is private health insurance with federal subsidies for those who qualify to help pay for it that’s available to purchase on marketplaces created by the Affordable Care Act. A majority of Americans who purchased Obamacare/ACA plans for coverage in 2022 qualified for subsidies, federal data shows.

Four out of five Americans who purchase 2023 Obamacare/ACA health insurance will be able to find plans for $10 or less per month when subsidies are included, federal health officials say. Several factors may affect pricing, including age, income, geographic area, and the tier of plan that one buys.

Nearly 200,000 Arizonans had Obamacare/ACA plans for coverage in 2022, up 29% from 154,504 in 2021, federal data shows. 

Obamacare marketplace monthly premiums for benchmark plans are up by an average of 4% across all 50 states and D.C, an Oct. 27 analysis from the Kaiser Family Foundation estimated, and up by about 5% in Arizona, though “the vast majority of marketplace enrollees receive a subsidy and therefore are largely shielded from these increases.”

Consumers “may need to switch plans to take full advantage of the subsidies,” the analysis says. 

Enhanced federal premium subsidies for Obamacare/ACA plans that began during the COVID-19 pandemic under the American Rescue Plan were extended under provisions of the federal Inflation Reduction Act that President Joe Biden signed into law this year.

Those enhanced subsidies “made such a significant difference,” to Scottsdale residents Anna and Gavin Laidlaw, who are currently covered by an Obamacare/ACA plan.

Prior to the enhanced funding via the American Rescue Plan, the Laidlaws earned too much to qualify for federal subsidies and they found the prices of Obamacare/ACA plans unaffordable. The Obamacare/ACA plans they were looking at had a monthly premium cost of about $700 per month for the two of them with a deductible of $15,000 per year. 

As a result, for a period of time, the couple opted to go without any health insurance at all, though it wasn't their preference.

The Laidlaws, who are in their 40s, own a health coaching business together and each has a second job, too. In 2022, the enhanced subsidies enabled them to find an Obamacare/ACA plan for about $110 per month for both of them, which included vision and dental coverage, and had a $15,000 annual deductible.

The Laidlaws are still comparing plans on the Obamacare/ACA marketplace for 2023 and will likely end up paying a higher monthly premium - about $250 per month, which is still much more reasonable than prices prior to the enhanced subsidies, Anna Laidlaw said. So far, they haven’t found a plan that includes vision and dental coverage. 

The Inflation Reduction Act ensures that the enhanced subsidies continue without interruption for an additional three years, through 2025, an Oct. 27 policy watch analysis from the Kaiser Family Foundation says.

Most Arizonans and Americans don’t need Obamacare health insurance because they’re covered through their employer or a government health insurance program like Medicaid or Medicare.

Still, there are many Arizonans who would qualify for low-cost subsidized Obamacare plans but aren't purchasing them, said Claudia Maldonado, director of outreach and enrollment for the Arizona Alliance for Community Health Centers.

About 750,200 Arizonans did not have health insurance in 2021, according to the Kaiser Family Foundation. Going without health insurance puts individuals and families at risk for prohibitive health care expenses in the event that an unexpected illness or accident occurs.

“Oftentimes, people don’t realize that it (Obamacare) is an option for them,” said Sheila Prior, president-elect of the Arizona Association of Health Underwriters. “I think it really comes down to the fact that people don’t know that they can get help for free and probably don’t realize the amount of money they could save because of the subsidies that the government provides.”

For those who do need Obamacare health insurance, believe they may qualify, or are wondering whether they can afford it, here are five things to know about the 10th annual open enrollment period:

Open enrollment goes through Jan. 15, but anyone who wants coverage to begin Jan. 1 needs to enroll earlier

The federal marketplace, which was created by the Affordable Care Act, typically has open enrollment in November and December, with enrollment during other parts of the year available only to people with certain qualifying circumstances such as losing a job.  

This open enrollment period for coverage in 2023 began Nov.1 and goes through Jan. 15, though anyone who wants their coverage to begin Jan. 1 needs to enroll by Dec. 15. To be eligible, Arizonans must be U.S. citizens or be lawfully present in the country and must not be incarcerated.

8 insurers will sell Obamacare plans in Maricopa County

Insurance companies are selling Obamacare plans for coverage in 2023 to residents of all 15 counties, though four counties will have only one insurance company selling plans: Blue Cross Blue Shield of Arizona is the only company selling plans in Apache, La Paz, Mohave and Navajo counties, Maldonado said.

In Maricopa County, which is Arizona's most populated county, eight insurers will sell plans, she said: Ambetter from Arizona Complete Health; Banner|Aetna; Blue Cross Blue Shield of Arizona; Cigna; Imperial Insurance Companies; Medica Community Health Plan; Oscar Health Plan; and UnitedHealthcare of Arizona

In Pima County, which is Arizona’s second-most populated county, four insurers are offering plans: Ambetter from Arizona Complete Health; Banner|Aetna; Blue Cross Blue Shield of Arizona; and UnitedHealthcare

Obamacare open enrollment is not the same as Medicare open enrollment

Medicare’s open enrollment period began Oct. 15 and goes through Dec. 7. Medicare is generally for people over the age of 65, younger people with disabilities and people with end stage renal disease.

The marketplace created by the ACA, often called Obamacare, is for working age people who earn too much to qualify for Medicaid (the Arizona Health Care Cost Containment System) and don’t have other health insurance coverage. Some states have their own insurance exchanges. Arizona uses the federal exchange, which operates via the websites: healthcare.gov and CuidadoDeSalud.gov or at 800-318-2596.

Get enrollment help from trusted sources and watch out for scams and deceptive marketing

Free help is available to enroll. No one should ask for payment to help with enrollment. And consumers should watch out for scams and misleading marketing of health insurance.

The Federal Trade Commission in August announced it was taking action against Florida-based Benefytt Technologies “for lying to consumers about their sham health insurance plans and using deceptive lead generation websites to lure them in.” The company was ordered to pay $100 million in refunds.

In its complaint against Benefytt, the FTC said the company and its third-party partners operated a series of deceptive websites like “Obamacareplans.com” that targeted consumers who were searching for Obamacare/ACA plans.

Consumers can avoid problems with companies like Benefytt by connecting with licensed and certified health insurance navigators and certified application counselors who will provide enrollment help for free in both English and Spanish. Arizonans may call Cover Arizona toll-free at 800-377-3536 or go to www.coveraz.org and there's an option to put in one's ZIP code to find nearby assistance.

Navigators and counselors also can help people sign up for AHCCCS and for KidsCare, a health insurance program for children whose parents make too much to qualify for Medicaid but not enough to afford private plans.

Consumers may also go through insurance brokers, or directly to insurance companies to enroll and that won’t cost any money, either. 

“A consumer can work with a broker for free. The brokers get their income from the carriers,” Prior said. “But I don't think a lot of people realize that that's a free service.”

Look at more than just monthly premiums when you are buying health insurance

Depending on the consumer, it’s important to consider more than just the monthly premium when deciding on plans to buy, Maldonado said. Factors to consider include the yearly deductible, the network of hospitals and doctors covered by the plan, and prescription drug coverage.

“Whenever anybody is looking for health coverage in the marketplace, it’s absolutely important that they review the out-of-pocket costs, the deductible,” Maldonado said. “We always encourage people to look through the network of providers as well, especially if they are managing a chronic health condition that requires them to work with a specific doctor.”

The Obamacare/ACA marketplace has levels of plans labeled bronze, silver and gold, with gold typically the most comprehensive. Federal subsidies are available for all levels and additional cost reductions are available for those who qualify and purchase silver level plans.

There are bronze level plans available to certain consumers for no monthly premium, but it's important for families to check their household health needs, Prior said. It might make more sense for a family to get a robust silver level plan that costs $80 to $100 per month than to opt for a zero-premium bronze plan, she said.

“If you are purchasing solely on price, you are not necessarily going to buy the right plan,” Prior said. “What can you stomach in terms of the maximum amount you will spend on care - not on the premiums, but on care every year? Because some of those plans have very high (annual) deductibles for a family. A bronze plan can be $17,000 for a family.”

Window shopping on healthcare.gov is available. This allows consumers to “look before they buy”: https://www.healthcare.gov/see-plans.