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With open enrollment underway, new rules could mean fewer people in marketplace plans

Gustavo Valdez, an insurance navigator with the Community Action Agency of St. Louis County helps Charles Niemeyer enroll in health insurance through the healthcare.gov website.
Camille Phillips | St. Louis Public Radio
In this file photo, Gustavo Valdez, an insurance navigator with the Community Action Agency of St. Louis County, helps Charles Niemeyer enroll in health insurance through the healthcare.gov website.

Nov. 1 marked the start of the six-week open enrollment period during which Missourians can buy health insurance on the federal exchange.

While enrollment in Missouri has been relatively stable in the federal marketplace’s five-year history, new federal rules could mean fewer people sign up for 2019 coverage.

“You could think of this as a triple whammy,” said Sidney Watson, health policy professor at St. Louis University.

Next year marks the first in which the government will not subject people to a financial penalty for not having insurance. While the individual mandate – the Affordable Care Act requirement that people have insurance – is technically still in place, Congress effectively muzzled it when it eliminated the fine for breaking the rule as part of the tax overhaul bill passed in late 2017.

That means some people, particularly healthy or young residents, might opt out of buying plans, said Nancy Kelley, program director at the Missouri Foundation for Health and the Cover Missouri coalition.

“Particularly someone who views themselves as relatively healthy, they don’t feel like they’re going to use that much health care, they might say, ‘I’m just going to take my chances and go without,’” Kelley said.

New alternatives

People sign up for plans on the exchange for many reasons, not just because they’re required, Kelley said.

“There’s a big group of people out there that get the value of having coverage,” she said.

What experts think might have more of an effect on enrollment is the increasing popularity of cheaper, short-term plans and association health plans. These non-marketplace insurance plans may offer fewer benefits for less money.

“Those plans aren’t regulated in the same way as ACA-compliant plans or even large employer plans,” said Kelley. “They don’t necessarily have to adhere to the protections the Affordable Care Act provides like the 10 essential health benefits and pre-existing conditions [coverage],” Kelley said.

This year, the Trump administration loosened rules on the two types of plans. Association health plans are plans in which people in small businesses can band together to buy insurance that doesn’t have to meet certain coverage requirements. In June, President Donald Trump introduced a rule that let more people gain access to such coverage.

Trump has also relaxed an Obama-era policy that limited short-term plans (which can offer fewer benefits) to three months. Now, those short-term plans can cover a person for 364 days – one day less than a year.

Buyer beware

Both options offer potentially cost-wary consumers a way to obtain coverage for less money, especially those who make too much to qualify for federal assistance to cover marketplace plans. But experts say buyers should be careful.

“The concern is they can provide less coverage, fewer benefits, have higher out of pocket costs than plans that are available on healthcare.gov,” Watson said.

The bottom line? Research the plan carefully, especially making note of any exclusions. If an insurer asks for a detailed medical history, it’s probably not an ACA-compliant plan, Kelley said.

If healthier patients flock to non-marketplace plans, the premiums for those who remain could go up in coming years or insurers could leave the marketplace entirely, Watson said.

In 2019, four insurers are offering plans in Missouri, though many counties will only have one provider to choose from.

Average marketplace rates increased somewhat for 2019. Healthy Alliance Life Insurance plans an average increase of about 4 percent, and Cigna’s plans will increase about 7 percent. Centene's Celtic Insurance plans an average decrease of 9 percent. Medica, a newcomer, will offer plans in the Kansas City area.

Close to a 245,000 people in Missouri bought a plan on healthcare.gov in 2018, Kelley said.

Sarah Fentem covers health for St. Louis Public Radio. Follow Sarah on Twitter: @petit_smudge

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