5 things to know about Affordable Care Act’s 2020 enrollment period | TribLIVE.com
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5 things to know about Affordable Care Act’s 2020 enrollment period

Natasha Lindstrom
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The percentage of U.S. adults without health insurance surged upward in 2018, reaching levels not recorded since before President Donald Trump took office, according to a new national survey. (Dreamstime/TNS)

Western Pennsylvanians shopping for 2020 insurance coverage through the federal health care marketplace can expect to see a small uptick in prices over last year and more plans to choose from.

Costs for 2020 individual plans increased statewide by an average of about 4%, state data show.

“It’s a slight increase, but it’s not double-digit increases,” said Antoinette Kraus, executive director of the Pennsylvania Health Access Network, which helps consumers find plans with state-approved navigators. “Pennsylvania has actually really worked hard to shield consumers from those steep rate hikes that happened in other parts of the country for the past few years.”

The Affordable Care Act exchange enrollment period for 2020 coverage begins Friday. Individuals have until Dec. 15 to sign up for a plan.

In most states, monthly premiums on the ACA marketplace are mostly down or flat. Some states reported significant increases, and a few reported increases near 10%, including New Jersey and Vermont. Colorado reported a nearly 20% decrease.

The nationwide average is an increase of less than 1%, and prices are expected to continue dropping next year, federal and industry research data show. Premiums increased by double digits in many states over the past three years before dropping 3% last year.

State Insurance Commissioner Jessica Altman said more insurers have entered Pennsylvania’s ACA marketplace, and returning insurers have rolled out more offerings and flexibility in benefits.

Only about 9,000 Pennsylvanians live in counties that only offer one health insurer option in ACA plans, down from nearly 180,000 people who lived in counties without multiple insurers in 2018, Altman said. The state has an uninsured rate of just 5.5%, the lowest ever in Pennsylvania, Gov. Tom Wolf said in a statement.

Oscar Health entered the marketplace in Philadelphia and its suburbs for the first time, and Highmark expanded into 14 new counties — including Fayette and Greene, which previously only had access to UPMC plans.

“We have a very competitive marketplace,” Kraus said. “We see more insurance companies opening up more choice.”

Here are five things to know about the 2020 ACA enrollment period:

What are my options?

Despite increased competition and more plan offerings statewide, most Western Pennsylvanians have the option of choosing from one of two insurers: Downtown Pittsburgh-based nonprofit health system rivals UPMC and Highmark.

There are dozens of specific plan options between the two insurers, with residents in Pittsburgh, for instance, having access to 32 different plans. The options vary by a patient’s residence and level of medical needs.

UPMC and Highmark retained the right to continue offering plans that exclude the other in their 10-year contract announced in late June.

How should I choose which plan is best for me?

Kraus encourages consumers to think about these key questions: Does this plan cover my doctors? Is it in my network? What are my medical needs and how much will I use them? What is the full cost?

“It’s really important to think not only about the monthly premium, but how much do you use medical care and what is the total cost,” Kraus said. “You could have a lower premium with high deductibles, and you’ll end up paying more out of pocket.”

About eight in 10 people with ACA individual plans qualify for financial subsidies that could reduce premiums to under $100 a month. People with incomes of more than $100,000 will not qualify for financial assistance.

Patients should be leery of websites that appear to mimic the healthcare.gov but only offer short-term insurance as opposed to the official ACA plans. Legitimate ACA plans guarantee a wide range of basic benefits and coverage that lasts the full year.

What if I miss the deadline?

Consumers can only sign up for plans after Dec. 15 under special circumstances or life-changing events, such as a divorce or a long-distance move. Most people will not qualify.

Individuals eligible for Medicaid can sign up any time through the state.

Are enough people signing up?

With nationwide decreases in premiums, observers say the ACA marketplace has not resulted in some of the sky-high prices feared by detractors when it became law in 2010.

Advocates of the law continue to have concerns, however, over President Trump’s persisting opposition to the ACA on several fronts, including backing a federal lawsuit that seeks to overturn the law in its entirety.

In 2017, the Trump administration slashed funding for ACA-related outreach and education from $90 million to $10 million. Health and Human Services Secretary Alex Azar reiterated earlier this month that the ACA “simply doesn’t work.”

Kraus said such moves from the top have made increasing sign-ups more difficult. The number of individuals on ACA plans fell from 12.7 million in 2016 to 11.4 million in 2019.

In June, Pennsylvania’s lawmakers approved a state-based health exchange they hope will increase participation and result in lowering prices by 5 to 10% starting in 2021.

Who can I contact for help?

Shop for plans at the ACA marketplace’s official website, healthcare.gov.

Reach the federal government’s 24-hour hotline at 1-800-318-2596 or visit localhelp.healthcare.gov to request in-person assistance.

The state also provides a tool called the Consumers’ Checkbook at insurance.pa.gov that allows consumers to see their options by ZIP code and plug in their income, number of family members and prescription drug needs to obtain cost estimates.

Reach a consumer navigator who specializes in ACA enrollment with PHAN at 1-877-570-3642.

State-licensed insurance brokers and navigators also can be good resources.

Natasha Lindstrom is a Tribune-Review staff writer. You can contact Natasha at 412-380-8514, [email protected] or via Twitter .

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