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Utah enrollment in ACA surpassing last year, but experts say some might be confused

Premiums nationwide on average are down 4% for 2020

Obamacare is far from perfect. It was cobbled together badly. Implementation has been problematic. Now that the legal battles over Obamacare are over, the president and the Congress should work together to fix the problems of the legislation. Jon Elswick, Associated Press

SALT LAKE CITY — The number of Utahns enrolling in insurance plans so far on the federal health exchange are surpassing last year’s, but insurance experts say some might still be confused about their options.

“Far too many consumers still believe coverage is too expensive or out of reach. And yet, roughly 80% of those that shop on the exchange qualify for financial assistance to make health coverage affordable,” according to Take Care Utah, a nonprofit that helps people enroll in health insurance through the Affordable Care Act.

As of Nov. 23, the most recent date for which the Centers for Medicare and Medicaid Services has released updated enrollment numbers, 62,090 Utahns had bought insurance on the federal health exchange. By comparison, Utah saw 56,105 people enroll last year by the same time, according to the services’ data.

National numbers

Open enrollment began on Nov. 1, and the last day to enroll in a plan on the exchange is Dec. 15.

Premiums nationwide on average fell 4% for 2020, according to the Centers for Medicare and Medicaid, as 20 more issuers are now participating — bringing with them more competition.

In Utah, Molina Healthcare reentered the health exchange market last year for 2019 in 10 of Utah’s 11 most populous counties. The organization recently announced for 2020 it expanded to include Box Elder, Morgan, Rich, and Wasatch counties.

“Our marketplace expansion will mean more choice for Utah residents shopping for insurance on the individual market,” Brandon Hendrickson, president of Molina Healthcare of Utah, said in a statement.

In Utah, the average benchmark plan premium decreased from $509 in 2019 to $456 in 2020, according to the federal data.

Overall in the U.S., 2,372,957 had signed up as of Nov. 23, compared to 2,424,913 last year — an about 2.1% decrease.

Many of those living on lower incomes remain unaware they’re eligible — even as a recent analysis from Avalere Health found that 96% of low-income residents in eligible counties can find a basic plan at no cost to them, the Associated Press reported.

While the administration of former President Barack Obama placed an emphasis on marketing during open enrollment, President Donald Trump, who has vocally opposed so-called Obamacare, decreased the program’s advertising budget, according to the AP. Federal officials have said they’re “focused on providing a quality sign-up experience and keeping the healthcare.gov website running smoothly,” the AP reported.

Take Care Utah — which provides “assisters” around the state who help people enroll — has seen the numbers of people in Utah seeking help enrolling consistent with last year’s, spokeswoman Maria Guadarrama said.

But she noted that numbers halfway into open enrollment aren’t an indication of how many will ultimately enroll. The group tends to see high numbers when the period begins on Nov. 1, followed by “a little bit of a slowdown in between the weeks.”

The organization expects to see a spike in people seeking help signing up during the two weeks before the Dec. 15 deadline.

Guadarrama said she believes that during open enrollment the past few years under the Trump administration, there has been some confusion about whether the Affordable Care Act still exists. And since Utah voters approved a full Medicaid expansion bill, which was later replaced by state legislators with a more limited expansion plan, some also don’t realize they might be eligible for Medicaid.

Utah’s options

Take Care Utah sees the open enrollment period as a chance to not only educate people about enrolling in insurance in the federal marketplace, but to also help them see if they might be eligible for Medicaid.

“Not only are we focused on open enrollment for the marketplace, but we help individuals and families, and screen them for Medicaid and CHIP. Because as household size changes and households’ income changes, people tend to be unaware that they potentially could qualify for Medicaid or CHIP,” which have all-year enrollment periods, she said.

Now, because full Medicaid expansion isn’t expected to happen in Utah until January, it’s unknown how many families enrolling in the marketplace now could transition to Medicaid, according to Guadarrama.

“But for right now, we do know that families that still qualify for adult expansion stay on Medicaid, and the families and individuals that qualify for the marketplace will enroll in those (plans),” she said.

The companies that offer plans on the federal health exchange in different Utah counties include SelectHealth, Molina Healthcare, University of Utah Health Plans and Cigna Healthcare.

Heidi Castenada, director of individual and small employer sales at SelectHealth, which offers 29 of the 54 plans available in Salt Lake County, said the company is also seeing average enrollment numbers.

SelectHealth premiums have been “stabilizing and dropping slightly” over the past couple of years, but premiums go up as people age, according to Castenada. Although the ultimate price has gone down slightly, the average person might see a slight increase as they get older, she said.

Regardless of provider, Castenada recommends those already in the marketplace to review their current plans and make sure the overall annual cost and coverage are appropriate for their needs. They should also reevaluate their provider networks every year, as there are a “variety of sizes and different networks that you can have access to,” she said. Some people pay more than they need to on a larger network, when they could access the providers they use regularly on a smaller network, Castenada said.

She also suggests looking ahead to what types of health care one might need for 2020, including upcoming surgeries or other events. As well as considering premiums, people should look at what their out-of-pocket costs will be for the entire year, she said.

“Combine those things together to kind of get an overall value of the plan you’re enrolling in. I think that’s something people overlook: they may be oversimplifying and just look at premiums, but there’s a better way to do it by looking at the overall value of the plan,” Castenada said.

People should also be aware of additional benefits different plans might provide them, such as virtual doctor visits.

Like Take Care Utah, SelectHealth also expects a surge of people enrolling as the deadline approaches.

“That is human nature to wait until the last minute to make decisions, and so yeah, we expect people right now to just kind of be thinking things through, doing their shopping. But a very large majority of people will wait until that very last minute to make a change,” Castenada said.

To review plans, visit healthcare.gov/lower-costs.