A sometimes overlooked provision of the Affordable Care Act could mean as many as 10,000 Central Virginians who re-enroll in Optima Health plans soon will be paying much larger shares of their insurance premiums.

Last year, the benchmark plan that determined subsidies in Charlottesville and Albemarle, Fluvanna and Greene counties was $1,000 per month. However, the re-entrance of Anthem HealthKeepers upsets the math. In 2019, a $485 Anthem plan will become the benchmark. In cutting premium costs by a third, Anthem plans will decrease the available subsidy to Central Virginians overall, as well.

Subsidies for people who receive insurance on the individual marketplace are designed to keep pace with the — typically rising — costs of premiums over time.

 “Competition is good for the Charlottesville area, but consumers will have to be much better shoppers than in the past,” said Sabrina Corlette, a professor at Georgetown University’s Center on Health Insurance Reform. “It’s not like buying a toaster oven. People will have to really look at their options and ask questions.”

In Virginia, people who make between 139 percent and 400 percent of the federal poverty level will be eligible for subsidies in 2019. People who make even a dollar above that face the “subsidy cliff,” and become responsible for the full price of their premiums.

According to rates filed with the State Corporation Commission, silver Optima plans in the Charlottesville area will cost between $669 and $820 per month in 2019. Silver Anthem plans will cost $443 and $485.

“So, your subsidy now is pegged to that $485,” Corlette said.

In 2018, the silver benchmark plan under Optima was $1,000 per month for a 40-year-old individual. While next year’s lower Optima premiums might seem like a financial win for that person, he or she may experience sticker shock at the amount they are expected to pay out-of-pocket.

“If they change plans to the lower-cost Anthem options, they should be fine,” Corlette said, “but there are lots of reasons why people don’t want to do that — keeping your doctor, keeping your prescriptions and drug formularies.”

With cutbacks to consumer navigation services, it’s more important than ever that consumers advocate for themselves and do their homework, Corlette said. Open enrollment for 2019 plans on the individual marketplace begins Nov. 1 and runs through Dec. 15. People can see if they are eligible and shop for plans at healthcare.gov.

An extra wrinkle is that people who make up to 139 percent of the federal poverty level will now be eligible for Medicaid, meaning they may need to switch from an ACA plan to Medicaid. More information on Medicaid eligibility can be found at coverva.org.

The consumer group Charlottesville for Reasonable Health Insurance, which sounded the alarm a year ago about spiking health insurance premiums, said it is concerned about the lack of transparency about out-of-pocket hikes. The group has requested a special enrollment period to give local consumers more time to weigh options.

“Apart from the special enrollment period, what we’re asking the Bureau [of Insurance] to do is to address the looming issue of consumers being misled about what their 2019 premiums will be,” said Karl Quist, a leader of the group. “We would expect them to intervene and make sure that Optima’s renewal letters contain accurate information and do not mislead consumers about their 2019 premiums. If [the Centers for Medicare and Medicaid Services] doesn’t allow a special enrollment period, it’s even more important that consumers be given accurate information about their 2019 premiums because once open enrollment is finished, they’ll be stuck with their plan until next November.”

The Bureau of Insurance said it is encouraging consumers to update their marketplace account information and check for lower premiums and financial assistance.

Any special enrollment periods, said spokesman Ken Schrad, would have to be approved by the Centers for Medicare and Medicaid Services, but “it is unlikely this would qualify as an SEP-causing event.”

Special enrollment periods are primarily for people who have lost other coverage or who have recently gotten married, had a baby or have changed residences. The Centers for Medicare and Medicaid Services did not provide an agent for media requests.

According to the Charlottesville for Reasonable Health Insurance group, several local agencies are offering enrollment assistance for people who qualify for insurance on the individual marketplace.

The following organizations already have begun making appointments for free insurance counseling:

» Legal Aid Justice Center: Call (434) 220-1496 for weekday appointments.

» Jefferson Area Board for Aging: Call (434) 817-5248 for weekday and some Saturday appointment.

Join our Mailing List

* I understand and agree that registration on or use of this site constitutes agreement to its user agreement and privacy policy.

Ruth Serven Smith is a reporter for The Daily Progress. Contact her at (434) 978-7254, rserven@dailyprogress.com or @RuthServen on Twitter.

Recommended for you

Load comments