Health insurance plans with zero premiums will be available to fewer low-income Mainers on the Affordable Care Act’s health insurance marketplace in 2019. But many higher-income enrollees – who have been hit with double-digit premium increases for years – will see flat or slightly lower premiums next year.

Thousands will begin selecting plans for 2019 in the coming weeks, as about 75,000 Mainers have health benefits through the ACA’s individual marketplace. Open enrollment runs from Nov. 1 through Dec. 15, and the price of the plans varies widely depending on a number of factors, including age, geography, income and the type of plan selected.

A LePage administration reform that takes effect in 2019 – a $90 million reinsurance program that redistributes money into the individual marketplace – is helping to keep premiums in check for next year, especially for some users.

The dynamic of some people experiencing lower health care costs while others pay more is typical of what happens in health insurance, experts say.

“All else being equal, these changes will be a net positive for the marketplace,” said Mitchell Stein, a Maine-based health insurance consultant. “Most people will have access to affordable health insurance.”

But some lower-income Mainers who snagged a zero-premium bronze plan last year will not have the same opportunity this year, thanks to the way federal subsidies that help people afford insurance are calculated.

Some enrollees could go from paying no premium to paying $25 to $60 monthly for bronze plans – which have the lowest premiums on the marketplace.

Last year, a 40-year-old single male living in Greater Portland and earning up to $27,000 could select a zero-premium bronze plan. This year, when choosing a plan for 2019, that same enrollee earning $27,000 would pay $30 to $65 a month for similar health benefits. Plan costs vary widely depending on many factors, so potential enrollees should check www.healthcare.gov starting Nov. 1 to see if they are eligible for zero-premium bronze plans.

SUBSIDIES OFFER SOME PROTECTION

The ACA splits up its plans into three tiers – bronze, silver and gold – with bronze plans featuring low premiums and higher deductibles, gold plans having generous benefits, lower deductibles and higher premiums, and silver plans falling in the middle.

People who earn between 100 percent and 400 percent of the federal poverty level – $20,780 to $83,120 for a family of three – are eligible for subsidies to help lower the cost of insurance.

The subsidies are based on a complex funding formula centered on the second-lowest-cost silver plan. In 2017, when the Trump administration ended certain ACA payments to insurers, some states, including Maine, devised complex workarounds that resulted in increased subsidies for enrollees who selected bronze and gold plans, leading to the zero-premium bronze plans.

 

Kevin Lewis, president and CEO of Community Health Options, a Maine-based insurer that has about 41,000 enrollees, said Community Health saw a huge spike in people selecting bronze plans, going from about 15-20 percent of plans selected to nearly half of all enrollees in 2018.

Even with slightly less generous subsidies for bronze enrollees in 2019, Lewis expects many will still choose bronze. Community Health Options’ bronze plans also include low-cost care for people with chronic conditions, such as diabetes, asthma and hypertension.

“It’s still a tremendous deal,” Lewis said. “People want coverage, but they want something that makes the family budget work.”

Overall rates – including bronze, silver and gold plans – for 2019 range from an 8.7 percent average decrease for Anthem enrollees, to a 4.6 percent average increase for Harvard Pilgrim plans and a 6.9 percent average increase for Community Health Options plans.

Enrollees who earn more than 400 percent of the federal poverty level and are not eligible for subsidies have seen premiums soar since 2014, although next year they could see a decrease.

The federal subsidies protect enrollees from the bulk of premium increases, but those who don’t qualify – often self-employed middle-class families who earn more than $83,120 for a family of three – have had to bear the full brunt of premium increases.

For those who earn too much to qualify for subsidies – about 10,000 Mainers – that has meant premium increases of roughly 70 percent to 110 percent since 2014, the first year the ACA marketplace went into effect.

‘ALWAYS CHECK THE OPTIONS’

For 2019, the price of the second-lowest-cost silver plan in Maine will decline 5-10 percent depending on where enrollees live, putting the brakes on cost increases for higher-income Mainers. Plans in northern Maine are generally more expensive than southern Maine.

Jane Rice, a financial adviser from Durham, said that’s fairly good news for her and her husband, David, who are paying a total of about $1,500 per month this year for their ACA bronze plans with an $11,000 deductible.

Rice said they can no longer afford silver plans, which would cost them nearly $2,500 monthly. Rice looked up the projected costs on Community Health Options’ website for 2019 plans, and their bronze plans will go up by “only” about $100 monthly, better than some years.

“That makes me feel halfway OK,” Rice said. “I’m kind of pleased it’s only $100 more, but it’s still a crazy amount to be paying for health insurance.”

Lewis said a number of factors go into the flat or slightly lower health care costs for 2019 – the Maine reinsurance program, insurers getting better at predicting costs, and more overall stability in the ACA marketplace.

Stein, the health insurance consultant, said enrollees should always shop around for the best plan and not assume that this year’s plan will cost the same next year.

“Things change from year to year, and for some, it’s going to be a lot different than last year,” he said. “Always check the options and really think it through.”

Joe Lawlor can be contacted at 791-6376 or at:

jlawlor@pressherald.com

Twitter: joelawlorph