“Window shopping” has begun for some people who get health insurance through the Affordable Care Act, and some patients could see their premiums increase significantly.
Juana Summers, host:
It’s been about a month since the United States entered a government shutdown with the Affordable Care Act, also known as Obamacare, still at the center of the fight. Democrats are holding on to a deal to extend tax credits that help people pay for health care through the ACA exchanges, warning that without these subsidies, health care costs would soar for tens of millions of people like Lynn Chernin(ph) of Tampa, Florida.
LYNN CHERNIN: I had emergency gallbladder surgery and got an $85,000 bill from the hospital.
Summer: She got that bill while she was still on private insurance and later switched to an ACA plan that she’s really happy with.
Chernin: Much better. They say the premium is huge. The out-of-pocket costs are surprising. You know, it’s – I feel really lucky.
SUMMER: Chernin’s friend and former colleague Laura Reynolds(ph) also signed up for Obamacare this year.
LAURA REYNOLDS: Surprisingly, it almost seems to cover better drugs than my insurance, for which I was paying almost a thousand dollars a month.
Summer: Yesterday, both women had an exchange where they were able to find out their projected expenses for next year. And for Chernin…
CHERNIN: My insurance premium will only go up by about a dollar a month.
Summer: Reynolds’ estimated premium, on the other hand, was more than $450 per month. This is a huge leap since her premium is currently $0. But she says it’s still possible, considering what it cost before Obamacare.
REYNOLDS: Because it’s still less money than if I paid it directly through the company I worked for.
SUMMERS: But Reynolds still has complaints. Not because of the cost, but because of the political fight over cost. Her stepdaughter, a civil servant, has been affected by the lockdown. The shutdowns continue while Democrats say they are fighting to make health care more affordable for millions of people like her.
REYNOLDS: It’s very upsetting that one of the things that’s shutting down our government right now is the debate over health care. You see, when we talk about the millions of people in the market, there is this small group of people who determine our health and our future.
Summer: Cynthia Cox conducts research on the Affordable Care Act for KFF, a health information nonprofit, and is here to analyze the current situation. illusion.
Cynthia Cox: Hello. Thank you for inviting us.
SUMMER: KFF’s research conducted through this week estimates that, on average, most Americans will see more than double what they pay for ACA health insurance. The exact figure rose again by an average of 114%. Now, given the “window shopping” phrase from the past, is there any reason to believe that most people won’t actually see a significant increase in what they are paying? I know one person in Florida said that the cost doesn’t actually go up that much.
COX: So these premiums are actually based on a formula. The amount someone pays is a percentage of their income. So for the majority of people who get tax deductions, it’s really easy to figure out how much more they actually have to pay. So our estimate that what people are paying on average will more than double is true. Of course, it will vary from person to person. For some people, the increase in premiums may not be very noticeable. Others could see astronomical increases in insurance premiums. But I think the reality is that, on average, people’s costs will double.
There are several things people can do to alleviate these costs. There may be a way to change the plan. For example, instead of a silver plan, you might choose a bronze plan with lower premiums but much higher deductibles. So there are definitely trade-offs that people need to consider.
SUMMERS: Cynthia, I mean, it’s not clear what’s going to happen at the Capitol. But even if lawmakers find a way to end the shutdown, they offer another plan that would extend Obamacare tax credits into next year. Has the damage already been done without any planning at this point? Can people still hold out hope for some kind of deal to extend the subsidies?
COX: The longer this situation goes on, the more damage it can do. The concern from the insurer’s perspective is that people are signing up and buying insurance now and they will see huge premium increases, which may be enough to scare them. As you know, just stopping your health insurance can be enough. So health insurers are concerned that healthier or younger people will drop coverage and sicker average people will sign up, resulting in higher costs and higher premiums.
And also, you know, if we want more people to get insurance, we want them to have complete information about what their plans are actually going to be and how much it’s going to cost in the next year. But at the same time, there is still time to make a change if Congress decides to extend the tax credit. People can shop right now, but the tax credit doesn’t actually expire until the end of the year. So, if Congress acts before December 31, the enhanced tax credit could go into effect in January.
Summer: So let’s say you’re someone who starts buying ACA marketplace insurance next year. What advice would you give them right now?
COX: Honestly, if I were you, I would wait a few weeks before shopping. There’s still a chance you’ll get a deal, and it’ll be okay to shop over the Thanksgiving holiday. You see, it will give you ample time to explore your options and sign up for coverage. It’s probably a good idea to decide on your health plan before December 15th so you can confirm your plan starting January 1st. Typically, this is when you need to make a decision about coverage beginning January 1. But if you wait a few more weeks, you’ll still have plenty of time to sign up.
That said, if you think you need someone to help you navigate the process, such as an insurance agent, broker, or health insurance navigator, reach out now and try to make an appointment, because this year will be very busy.
Summer: Cynthia Cox, vice president and director of Affordable Care Act programs at the nonprofit KFF. Thank you very much.
COX: Thank you.
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