WASHINGTON – With one week left to sign up for coverage under the Affordable Care Act, advocates are urging Arizona consumers to “window shop” for insurance plans that may be cheaper than they expected or, in some cases, essentially free.
“People don’t know about the discounts until they try,” said Allen Gjersvig, director of navigator and enrollment for the Arizona Alliance for Community Health Centers. “We need to combat the idea that, ‘It’s unaffordable to me.'”
The push by advocates comes against a looming Dec. 15 deadline to enroll for 2018 health insurance under the Affordable Care Act, or Obamacare. It also follows months of efforts by the White House and congressional Republicans to kill or weaken the ACA and, for Arizonans at least, follows a year in which they saw premiums more than double, a 116 percent average increase that was the highest in the country.
This year, however, premiums in Arizona are expected to increase by 2 percent or less for most plans, and advocates are pushing to get the word out.
The ACA offers plans on the exchange in four levels – bronze, silver, gold, platinum – ranging from higher deductibles and less coverage in the bronze to higher premiums in the gold and platinum.
“Somebody under the age of 30 earning a little bit too much so they don’t qualify for AHCCCS (the Arizona Health Care Cost Containment System, the state’s version of Medicaid) – they can get a free bronze health plan because their tax credit will be greater than or equal to the amount of a premium,” Gjersvig said.
He said 21-year-old in Arizona who makes $18,000 can qualify for a health care plan in 13 counties where the monthly premium would be completely covered by tax credits. The same plan in Maricopa and Pima counties would cost under $3 per month – “hard to beat if you are young and healthy,” Gjersvig said.
Critics acknowledge that there are affordable plans available, but said they may not be the best deal for everyone who is looking for coverage. In essence, they say, you get what you pay for.
“The lower-tier plans have the same essential benefits as the other plans,” said Michael Tanner, senior fellow at the Cato Institute. From bronze to platinum, the difference is in the size of the copayment, the deductible and out-of-pocket expenditures.
For the young and healthy, the bronze plan is “probably a pretty good deal for you,” Tanner said, but people with illnesses and chronic health problems “will end up paying more” for the coverage they need.
Gjersvig agreed that the lower-level bronze option is more “aimed at young adults” who don’t require as much medical attention and who are likely “low income because they are young.” Older people are “more likely to want more of a robust plan.”
But even those plans may not be all their cracked up to be, said Twila Brase, president of Citizens’ Council for Health Freedom.
“The real question is what kind of care are you going to get?” Brase said. “There is a promise of coverage, but there’s no guarantee of what kind of care you are going to get.”
Brase, who said she has “never been a fan of the ACA,” said the legislation has actually raised the cost of care for many, has decreased access and choices, and limits enrollment to the same period for everyone. And, she notes, those who do not have coverage, through an employer or on their own, will face a penalty of at least $695 when they file their taxes next year.
“The ACA mandated managed care for all. And you are limited to your network,” which tends to be narrow, Brase said. “There are fewer doors for anyone to go into, with longer waiting times, fewer options and fewer specialists.”
But supporters point to the millions of people who have been able to receive coverage under Obamacare.
Obama himself released a promotional video on Twitter when open enrollment season started on Nov. 1, saying “8 in 10 people can find plans for $75 or less. That’s cheaper than a lot of cell phone plans.”
Gjersvig echoed that, saying that for many low-income residents, signing up could cost “less than one cup of Starbucks” per month.
The enrollment push comes as President Donald Trump’s administration has slashed funding for ACA advertising and outreach, cut the enrollment period from 90 days to 45 and ended cost-sharing payments to insurers that were meant to offset the expense of providing low-cost plans, a requirement of Obamacare.
Those cuts may be reflected in many providers’ premium costs for 2018, which accounts for the jump in costs many may see for the silver plan, “the most popular by far,” Gjersvig said.
Still, analysts say the two insurance providers in the Arizona marketplace have posted only 1 to 2 percent premium increases on average for the silver plan, which Gjersvig said costs about $50 more a month than the bronze plan.
People should weigh their current and potential medical needs against costs they see on the website to find the best deal, Gjersvig said. If out-of-pocket costs for a plan outweigh the cost of a silver plan, for example, it is better to upgrade.
Estimates on the healthcare.gov website match actual premium costs “very closely,” Gjersvig said, and the Kaiser Family Foundation provides a calculator on its website to estimate a person’s penalty for being uninsured next year.
“You don’t know what your discount is going to be until you try,” he said.