Health exchange choices draw look

Some in state to pay lower premiums

Although premiums for health insurance bought on individual exchanges are going up nationwide, most Arkansas consumers can avoid some or all of the financial hit by shopping around during the open-enrollment period that started Tuesday and runs through Jan. 31.

For instance, St. Louis-based Centene Corp. is offering a new silver-level plan, designed to cover 70 percent of a typical consumer's medical expenses, for next year that has a lower premium than that of any silver plan that was available this year.

A 45-year-old Pulaski County resident who did not qualify for a subsidy would pay a monthly premium of $329.92 for the plan, known as Ambetter Balanced Care 6.

That's more than $17 a month less than a person the same age would pay this year for Arkansas Blue Cross and Blue Shield's Silver 3350 plan, which is the cheapest silver-level plan available in the county this year.

Andy May, an insurance agent in Newport, said Thursday that he had already helped two people who decided to switch to Centene plans.

"It was a significant enough savings, they were willing to make the change," May said.

The open-enrollment period is the time when people who buy insurance on their own, rather than through an employer, can sign up for coverage or change plans.

According to the Menlo Park, Calif.-based Kaiser Family Foundation, 249,000 Arkansas were uninsured as of early January, including 102,000 who were eligible for Medicaid and 47,000 who were eligible for other subsidized coverage through the exchange.

Those who go without coverage face a penalty of up to 2.5 percent of their household income above the tax filing threshold, which was $10,300 for an individual last year.

The health exchange, accessible through healthcare.gov, makes tax-credit subsidies available to many people with incomes of less than 400 percent of the federal poverty level -- $47,520 for an individual, for instance, or $97,200 for a family of four.

Under the so-called private option, Arkansas also uses silver-level exchange plans as a primary way of providing coverage to people who became eligible for Medicaid under the expansion of the program approved by the Legislature and then-Gov. Mike Beebe in 2013.

The expansion extended Medicaid eligibility to adults with incomes of up to 138 percent of the poverty level: $16,394 for an individual, for example, or $33,534 for a family of four.

More than 300,000 Arkansans were enrolled in private-option plans as of Sept. 30.

Meanwhile, 58,953 Arkansans were in non-Medicaid plans on the exchange as of Tuesday.

Although the state is paying 5 percent of the private option's cost next year, the state budget won't benefit from Centene's lower-priced silver plan because the company is not offering it to private-option enrollees.

But the premiums for the company's private-option plan, Ambetter Balanced Care 7, are dropping 2 percent next year in the state's central coverage region, which includes Pulaski County.

In the state's six other regions, the premiums for the plan are increasing in amounts ranging from 4 percent in the state's northeastern region to more than 15 percent in the southeastern region.

In addition to silver plans, insurance companies offer cheaper bronze plans, designed to cover 60 percent of a patient's expenses, and more expensive gold plans, designed to cover 80 percent of expenses.

But silver plans are the most popular because they make additional subsidies available to people with incomes of up to 250 percent of the poverty level.

The additional subsidies lower a silver plan's co-payments, co-insurance and deductibles so that the plan covers a greater share of a typical patient's medical costs: 94 percent for someone with an income of up to 150 percent of the poverty level, 87 percent for a person with an income of 150 to 200 percent of the poverty level and 73 percent for an enrollee with an income of 200 to 250 percent of the poverty level.

According to the U.S. Department of Health and Human Services, more than 87 percent of Arkansans enrolled in non-Medicaid plans on the exchange as of February were receiving tax-credit subsidies, which are paid directly to insurance companies to lower a plan's premium, and 70 percent were in silver plans.

Arkansas Blue Cross and Blue Shield offered the cheapest silver plan in five of the coverage regions this year, while Centene had the cheapest silver plan in the other two.

Next year, however, the premiums for Blue Cross plans are increasing an average of 9.7 percent, while those of Centene Corp. are going up an average of just 4 percent.

As a result, Centene will have the cheapest plan in every metal level in five of the state's seven coverage regions. In the other two regions, covering 24 counties in the southeastern and southwestern corners of the state, Centene will have the cheapest silver and gold plans, while Blue Cross will have the cheapest bronze plan.

Little Rock-based QualChoice Health Insurance had the cheapest bronze plan in one region this year, but will not have the cheapest plan of any metal level next year, when its premiums will rise an average of about 11 percent.

The company does have the cheapest catastrophic-coverage plan in each coverage region. Those plans, which offer less coverage than bronze plans, are available to people under age 30 or who would otherwise have to pay more than 8 percent of their incomes for insurance.

People enrolled in catastrophic-coverage plans are not eligible for tax-credit subsidies.

Arkansas Blue Cross and Blue Shield spokesman Max Greenwood said she doesn't expect a large number of customers to move out of her company's plans.

In addition to the monthly premium, customers consider a plan's network of providers and the drugs it covers, she said.

Blue Cross also has "hundreds of nurses on staff who reach out to folks to help them navigate the system," as well as programs that help people manage chronic health conditions and expensive medical needs, Greenwood said.

Customers "understand that we provide an array of services that are more than just a price point," she said.

As of September, more than 200,000 people were in the company's exchange plans, including 149,000 who were enrolled in the private option.

John Ryan, chief executive of Centene subsidiary Celtic Insurance Co., didn't return a call seeking comment Friday.

Robin Fletcher, an insurance agent with the Hatcher Agency in Little Rock, said she's been fielding a steady stream of calls from customers who received notices that their premiums will increase next year or that they need to visit healthcare.gov to update information about their expected income for next year.

"People are going to be moving and making changes," Fletcher said.

A Section on 11/05/2016

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