‘Not much change’ reported for exchange health plans ahead of November start of enrollment period

CHARLESTON, W.Va. — Residents in nine more West Virginia counties will see a second company on the Mountain State’s health insurance exchange via healthcare.gov when the enrollment period for 2020 begins on Nov. 1.

CareSource is now offering plans with the potential to be subsidized, depending on income, in more counties this year — 44 total — alongside Highmark Blue Cross Blue Shield which remains the only company serving all 55 counties via the exchange.

CareSource 2020 West Virginia exchange map with covered counties in purple.

The new CareSource counties are Braxton, Grant, Lewis, Nicholas, Pocahontas, Randolph, Summers, Tucker and Upshur.

Overall, “There’s not much change,” said Ellen Potter, health policy director for the West Virginia Offices of the Insurance Commissioner.

“We had single-digit (premium) increases with both companies. The people who actually are receiving the subsidies, their premiums shouldn’t see a change at all unless their income has changed.”

That’s a sign of market stability, in Potter’s view.

“Our companies have gotten accustomed to the enrollment that they have,” she said.

Nationwide, officials with the U.S. Department of Health and Human Services said this week that many exchange customers are in for premium declines.

In six states — Utah, Oklahoma, North Dakota, Nebraska, Montana and Delaware — premium decreases were greater than ten percent.

Premium increases were said to total more than ten percent in three states: Louisiana, New Jersey and Indiana.

In contrast to West Virginia, many exchange customers in other parts of the U.S. have more choices for plans with nearly 70 percent of the marketplaces including three or more insurers.

Exchange enrollment, though, has eroded under President Donald Trump who pledged to repeal and replace the health care law implemented under former President Barack Obama with legislation that is frequently referred to using his name, Obamacare.

Numbers were down to 11.4 million enrollments this year, DHHS reported, from a 12.2 million in 2017.

For 2019, 22,600 West Virginians are enrolled in health insurance plans through the exchange which reflected a decline of about 5,000 enrollments from 2018, according to Potter.

“Part of that is due to some people are aging into Medicare. We do have an older population in our state and, some of the people who are paying the full cost of insurance, they may have opted not to continue it because of the expense,” she said.

About 12 percent of exchange customers in the Mountain State receive no premium subsidies.

The new enrollment period on exchanges or marketplaces is open to people who don’t have other health insurance options either through an employer or a government program, like Medicaid or Medicare.

It runs from Nov. 1 to Dec. 15 for coverage to start on Jan. 1, 2020.

After Dec. 15, enrollments are only allowed in cases of life changes.

There is no longer a penalty for not having health insurance. Members of the U.S. House and U.S. Senate removed that requirement after President Trump took office.

That removal is at the heart of a case that’s pending with the U.S. 5th Circuit Court of Appeals in New Orleans, La.

Attorneys for Texas and more than a dozen other states, including West Virginia, have argued that the ACA is unconstitutional because the individual mandate, treated as a tax in an earlier U.S. Supreme Court decision, is no longer part of the law.

Those with the Trump Administration have sided with the plaintiffs and opted not to defend the law.

Any decision will likely be appealed to the U.S. Supreme Court.

“If anything is changed, it’s not going to take effect in this year. It would take a lot longer for the companies to react with any rate filings or any changes that would affect the policies,” Potter said of ACA’s future.

“For the new enrollment coming up, 2020, they (enrollees) wouldn’t see any change, so they should just go ahead and continue as usual.”

Enrolling through healthcare.gov remained the only way to secure potential subsidies.

For 2019, 88 percent of the people who enrolled in health insurance plans through West Virginia’s exchange received subsidies in some amount.

“There are websites that aren’t the official website out there,” Potter warned.

Other sites could offer health insurance plans that are not compliant with the Affordable Care Act.

For ACA compliance, “When you apply for coverage, you’re guaranteed coverage, there’s no pre-existing conditions and you’re not rated for any medical conditions,” said Potter.

She said exchange plans from Highmark and CareSource along with one off-exchange health insurance plan from The Health Plan meet ACA requirements.

Free assistance with enrollments is available from community assisters, navigators working with First Choice Services and certified agents. A full list of helpers, broken down by county, was posted at wvinsurance.gov or could be accessed by calling 888-879-9842.

Local insurance agents are also good resources, said Potter, as are the health insurance companies themselves.





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