During the open-enrollment period that starts today, thousands of low- to moderate-income Arkansans who buy health insurance through healthcare.gov will have the option to lower what they pay in monthly premiums starting in 2018.
Those lower costs are partly because of a decision by one of the 2010 Patient Protection and Affordable Care Act's biggest critics: President Donald Trump.
Last month, Trump decided to end a type of subsidy, known as cost-sharing reduction payments, that had reimbursed insurers for providing enhanced coverage to consumers with incomes of up to 250 percent of the poverty level.
Insurers are required to provide the enhanced coverage regardless of whether they are reimbursed. To make up for the loss, officials in Arkansas and other states allowed insurance companies additional increases in the premiums they will charge for coverage through the federal insurance portal starting in 2018.
The additional premium increases in Arkansas were concentrated mainly in so-called silver-level plans, which are the ones that provide the enhanced coverage for low-income consumers.
That in turn triggered an increase in a different type of subsidy that wasn't affected by Trump's decision.
That other subsidy, provided in the form of federal tax credits, lowers the cost of premiums for many consumers with incomes up to 400 percent of the poverty.
The amount of the credit is tied to the consumer's income and the cost of the second-cheapest silver plan available where the consumer lives.
For a 27-year-old, the average monthly premium in Arkansas for that plan, known as the benchmark plan, will increase 20 percent, from $248 to $298, according to a report by the U.S. Department of Health and Human Services.
For a consumer of that age with an income of $25,000, the average tax credit will increase 81 percent, from $89 to $161, according to the report.
Although based on the cost of a silver plan, which is designed to cover 70 percent of a typical consumer's expenses, the tax credit also can be used to purchase coverage in other types of plans.
That includes cheaper bronze plans, designed to cover 60 percent of a typical customer's expenses, and more expensive gold plans, designed to cover 80 percent of such expenses.
The premiums for bronze and gold plans won't increase by as much in 2018 as the premiums for the silver plans will. As a result the bronze and gold plans will be cheaper next year, compared with this year, for many consumers who qualify for the tax credits.
According to the Health and Human Services Department report, 67 percent of Arkansans who buy coverage through healthcare.gov would pay $75 a month or less next year if they enrolled in the cheapest plan available to them.
By comparison this year, only 52 percent of enrollees had the option of enrolling in a plan with a monthly premium that low.
Nationally, among states such as Arkansas that use the federal enrollment platform, the number of enrollees who have the option of paying less than $75 a month for coverage increased from 71 percent this year to 80 percent in 2018.
Marquita Little, health policy director for Arkansas Advocates for Children and Families, said such changes are one reason consumers who buy coverage on their own, rather than through an employer, should visit healthcare.gov to explore their options.
"A lot of people just assume or hear things, like, 'Oh it's unaffordable. [The cost of] coverage is skyrocketing.' So they don't check," Little said.
Little also recommended that consumers seek one-on-one help with one of the 11 so-called navigators employed by several organizations across the state with funding provided by the Arkansas Health Insurance Marketplace, which certifies the plans sold in the state through healthcare.gov.
Navigators employed by Future Builders of Wrightsville will be stationed today at the Laman Library in North Little Rock from 10 a.m. to 4 p.m.
Marketplace spokesman Alicia McCoy said consumers can also find contact information for navigators, as well for insurance agents and other licensed helpers, on the marketplace website, myarinsurance.com.
Consumers also can contact an insurance agent or navigator by calling the marketplace call center at (844) 355-3262.
The open-enrollment period is the time each year when people who buy coverage on their own, rather than through an employer, can sign up or change plans.
People covered by private, Medicaid-funded plans under Arkansas Works, as the state's expanded Medicaid program is known, are also limited to changing plans during the open-enrollment period, although people without coverage can sign up for the Medicaid program throughout the year.
More than 53,000 Arkansans were enrolled in non-Medicaid plans offered through healthcare.gov as of Oct. 15, according to the Arkansas Insurance Department.
As of Jan. 31, 84 percent of such enrollees in the state qualified for the tax credit assistance, according to the Health and Human Services Department report.
Those who don't receive the tax credit help will face the full brunt of the premium increases that will take effect in 2018. That includes average increases of 14.2 percent for plans offered by Arkansas Blue Cross and Blue Shield, 9̶.̶9̶ 21.4* percent for those offered by St. Louis-based Centene, and 25 percent for those offered by Little Rock-based QualChoice Health Insurance.
In addition to higher premiums, some consumers also are facing changes in benefits that will start in 2018.
For instance, according to information provided to insurance agents, Arkansas Blue Cross and Blue Shield has revamped several of its plans and is discontinuing five plans that covered more than 20,000 people as of Aug. 1.
Those affected will be transferred to different Blue Cross plans on Jan. 1 unless they make another selection during open enrollment.
The changes are "sending a lot of people into panic," said Robin Fletcher, an insurance agent at the Hatcher Agency in Little Rock.
She said she plans to begin working down a list today of 125 people who have contacted her since August for help signing up or re-enrolling during the enrollment period, which runs through Dec. 15.
"I think for some, it's going to be better," she said. "For some it's going to be worse."
A Section on 11/01/2017
*CORRECTION: The rates for Centene plans offered in Arkansas through the state’s health insurance exchange will increase an average of 21.4 percent next year, according to the Arkansas Insurance Department. A previous version of this story listed an incorrect percentage increase.