Virginians shopping for plans on the Healthcare.gov marketplace should expect premiums to be moderately higher than last year, but nothing like the sticker shock some had speculated would result once insurers had first-year claims data.
Picking a health plan continues to be complicated, though, requiring consumers to click through multiple links to get information on what hospitals and providers are in a plan’s network.
Open enrollment for the second year of the Affordable Care Act marketplace kicked off Saturday. People who want coverage that starts Jan. 1 need to sign up by Dec. 15. The marketplace will be open for enrollment through Feb. 15.
“The rates and plans for our (Affordable Care Act) products are very similar to last year,” said Scott Golden, spokesman for Anthem Blue Cross and Blue Shield, the state’s largest health plan in terms of enrolled members. “We’ve made a few minor tweaks, but nothing substantial.”
Anthem’s lowest-cost “silver” plan on the marketplace available to the typical 40-year-old nonsmoker in the Richmond area is a HealthKeepers Silver X health maintenance organization with a $264 monthly premium. The plan has a $3,350 annual deductible. A similar plan for 2014 had a $258 premium.
The plans on the marketplace are grouped by metal levels. Bronze plans are cheaper, silver-level plans moderate, while gold- and platinum-level plans have higher monthly premiums but richer benefits. In addition, low-premium, high-deductible catastrophic plans are available to people under age 30 and those who get a hardship exemption.
Another low-cost silver plan available in the Richmond area is a Coventry Health Care of Virginia plan with a $241 monthly premium for a 40-year-old nonsmoker, up from $230 last year.
Again this year participants who chose some Anthem HealthKeepers plans on the exchange will find their in-network hospital choices limited to HCA Virginia facilities. Similarly, Coventry plans have Bon Secours facilities as preferred providers.
“Our silver-level plans do not exclude hospitals other than Bon Secours. However, you would pay more out of pocket to go to another hospital,” a Coventry spokesman explained in an email. “The only plans we have that do not cover out-of-network care are our catastrophic bronze and deductible-only bronze plans.”
On average, 2015 premiums for individual plans available to Virginians shopping on the marketplace are up 10.2 percent from 2014, with a range among plans of 1.9 percent to 18.2 percent, according to an analysis of rate filings by PricewaterhouseCoopers’ Health Research Institute. Across all metal levels and age levels, the average monthly premium in Virginia is $354, according to the report.
A report from The Urban Institute that looked at local health care markets found an average 4.9 percent increase in the premium for a silver-level plan in the Richmond area.
“The increases are relatively modest for people who were already in an (Affordable Care Act) plan,” said Doug Gray, executive director of the Virginia Association of Health Plans.
About 216,000 Virginians enrolled in plans during the first year of the Affordable Care Act. The data show 82 percent got some sort of financial assistance, and at least 62 percent of them were in silver plans, Gray said.
People shopping for plans are advised to check not only the monthly premiums, but also co-pays for prescriptions and office visits, annual deductibles and out-of-pocket maximums.
Subsidies in the form of advance tax credits are available to help people with income between 100 percent and 400 percent of the federal poverty level afford premiums. Some people have qualified for subsidies that cover the entire monthly premium.
In addition, people between 100 percent and 250 percent of the federal poverty level who enroll in a silver-level plan are eligible for additional cost sharing — such as lower co-pays for doctors’ visits and prescriptions.
For instance, a 29-year-old Richmonder making $20,000 a year could qualify for a $144 monthly subsidy, which would reduce the premium for an Anthem HealthKeepers silver plan to $86 a month.
In the Richmond area, Anthem, Coventry and Optima are offering a total of 11 bronze plans, eight silver plans, four gold plans and three catastrophic plans.
“Everyone absolutely is predicting an influx of new applications in addition to the folks who need to renew their policies,” said Jill Hanken, an attorney with the Virginia Poverty Law Center, which has a grant to do Affordable Care Act outreach.
Consumers, she said, need to start shopping now.
“It’s important to take your time, especially in terms of plan selection, to make sure that you are selecting a plan that is going to work well for you and your family,” Hanken said. “You need to make sure you have your providers in the health plan’s networks and your medication in the plan’s formulary. All that can be time-consuming,” so consumers shouldn’t wait until the last minute, Hanken said.
Gray said consumers switching to a different plan need to notify their old plan.
“One challenge we are going to have is that the federal government exchange does not have the ability to notify the old plan when you select a new one,” Gray said. “That could be problematic if the consumer does not notify the old plan and they have automatic payments set up.”
Virginia this year will have a lot more navigators and application counselors helping people enroll, thanks to a $9.3 million federal grant. Gov. Terry McAuliffe talked about those efforts Thursday at an open-enrollment event at the Vernon J. Harris Medical and Dental Center in Richmond. The center in Church Hill last year helped enroll more than 1,000 of the 216,000 Virginians who bought coverage in marketplace plans.
The state wants to sign up an additional 160,000 people this year of an estimated 300,000 uninsured who are eligible for tax credits.