By Mark Tosczak
North Carolinians who buy health insurance from Healthcare.gov under the Affordable Care Act will face double-digit premium increases, though most consumers will also receive subsidies to offset those increased costs.
A six-week open enrollment period starts Nov. 1.
Blue Cross and Blue Shield of North Carolina confirmed this week that premiums for its ACA plans would rise by 14.1 percent in 2018.
A company spokesman said the average individual premium for its ACA plans was $655 per month in 2017, although after subsidies members paid an average of $155 per month.
That suggests the average premium for 2018 will be around $747 per month, though the amount paid by most people will be lower. Subsidies cover part of the premium cost for those with incomes up to four times the federal poverty level — $48,240 for an individual, $98,400 for a family of four.
About 90 percent of the 500,000-plus North Carolinians now enrolled in Blue Cross exchange receive a subsidy to help pay for premiums, the company said.
The only other health insurer that sells ACA exchange plans in North Carolina is Cigna. Earlier this year the company filed a rate increase request of 32 percent. The company declined to say what its 2018 rates will be. Spokesman Joe Mondy did confirm that Cigna will continue to offer plans in five counties: Chatham, Orange, Wake, Johnston and Nash.
Those whose incomes are too high for subsidies will be stuck with the higher premiums if they remain on the exchange plans, though.
Blue Cross and Blue Shield also sells individual plans that don’t meet all ACA requirements, but those are only available to people who have been buying them since the health reform law took effect in 2013.
That year, the company sold such plans to about 161,000 people. By this year, the number of people left in that pool had dropped to about 50,000. The costs of those plans can vary widely depending on the age of the insured, plan design and other factors. Unlike ACA plans, people who enroll in these plans can’t receive subsidies, regardless of their income level.
Blue Cross spokesman Austin Vevurka said the company will offer those plans again for 2018, but their future in 2019 and beyond is, at best, uncertain.
“By law transitional plans are scheduled to end 12/31/18,” he said in an email. “In the event legislation changes, we will evaluate whether we will continue offering.”
The big increases in ACA plans are in sharp contrast to the modest increases in the cost of health care purchased through large employers. According to benefits consultancy Mercer, employer-sponsored health plans will rise by about 4.3 percent in 2018.
Mercer noted that, nationally, the increase would have been about 6 percent if employers weren’t taking steps to hold down costs. Those include switching insurance companies or making changes in so-called “plan design,” such as increasing deductibles.
Turmoil from Washington
The see-saw on health care in Washington over the last few months, with multiple attempts to “repeal and replace” the ACA failing on razor-thin votes in the Senate, has contributed to uncertainty for both consumers and insurance companies.
Last week, the Trump administration said it was ending the cost-sharing reduction (CSR) payments to insurers. Such payments go to insurers, which in turn use them to lower the cost of copays, deductibles and other out-of-pocket costs for customers with incomes up to 250 percent of the federal poverty level.
Insurers are required to provide those out-of-pocket discounts. Blue Cross and Blue Shield, anticipating the CSR payments might disappear, asked for higher premium increases to make up the difference. Ironically, that likely means taxpayers will end up kicking in more money in the form of premium subsidies to offset the higher premium costs.
Blue Cross said this week that if CSR payments had been left in place, its average premium increases would have been near zero for ACA plans.