Health & Family

Despite problems, ACA plans under $100 available for some. Sign-ups start Nov. 1

In this photo from 2015, Gelila Selassie (right) assists a customer in signing up for health insurance through the online marketplace during an event at Legal Services Southern Piedmont.
In this photo from 2015, Gelila Selassie (right) assists a customer in signing up for health insurance through the online marketplace during an event at Legal Services Southern Piedmont.

With the exodus of two large insurance companies, most North Carolina customers using the Affordable Care Act’s online marketplace will be left with only one insurer when enrollment opens Tuesday.

Premiums will be higher for many marketplace customers who earn too much to qualify for federal subsidies. But the government projects 85 percent will be able to find insurance plans with premiums of less than $100 a month because they’ll be eligible for premium tax credits.

Citing huge losses on ACA business, both UnitedHealthcare and Aetna announced earlier this year they would withdraw from North Carolina’s online marketplace for 2017, meaning more than 200,000 customers will have to look for new coverage.

That leaves Blue Cross and Blue Shield of North Carolina, as the only insurer offering plans in all 100 counties. The Charlotte area will have 11 plans to choose from, with a range of premiums. Cigna plans to offer coverage in five counties around Raleigh.

Two weeks ago, Blue Cross announced it will increase premiums by an average of 24 percent. That’s on top of last year’s average increase of 32.5 percent – one of the highest in the country for 2016.

Again this year, Blue Cross will offer two networks – Blue Value includes Novant Health and Blue Local includes Carolinas HealthCare System. “Even without Aetna and United in the marketplace, people will still have options,” said Madison Hardee with Legal Services of Southern Piedmont.

Lovemore Masakadza, with Enroll America, a nonprofit, nonpartisan coalition of enrollment advocates, urged consumers to meet with navigators to get help understanding their options. “Even for those who are still under Blue Cross, there are going to be new plans and new prices.”

Despite rate increases and continuing criticism, the ACA has been popular in North Carolina, which has the fourth-highest enrollment in the country. More than 545,000 people enrolled for 2016, and more than 90 percent are getting financial assistance to help pay for premiums.

Those customers who got subsidies will “largely be shielded from premium increases,” Hardee said. “.…When premiums increase, so do premium tax credits.”

Federal assistance is also available to reduce the cost of deductibles, coinsurance and copays for those with incomes up to 250 percent of the poverty level that are enrolled in “silver” plans accompanied by tax credits.

Hardee urged people “not to rule themselves out before they see what options are available.” In addition to scheduling appointments with navigators or insurance agents, she suggests using the marketplace online tool ( to preview 2017 plans and prices.

‘Significant problems’

The rise in premiums and the exit of insurers are signs the ACA marketplace is “unaffordable for both consumers and taxpayers,” warned Devon Herrick, a senior fellow at the National Center for Policy Analysis.

“The average benchmark premium rose 25 percent to $302 per month. Yet the Administration assures us nearly three-quarters of Americans on will be able to find a premium for less than $75 per month,” Herrick said in a statement.

“That suggests taxpayers are bearing the brunt of the massive rate hikes. Insurers are fleeing the exchange because they are losing money despite charging high premiums. The only Americans who find Obamacare to be a good deal are those that receive generous subsidies and those who are sick.”

Jonathan Oberlander, a health care policy expert at UNC Chapel Hill, agreed there “are signs of significant problems.” He said the marketplace was “built on the presumption of competition (with) multiple insurers competing against each other, which in theory will give people choices and keep costs down.”

During the first years of the ACA marketplace, premium increases were modest and lower than forecast, Oberlander said. “The question is what happens going forward. Is this a blip?…Or is this part of a pattern?”

Oberlander said he’s concerned that news about premium increases could cause people who would be eligible for subsidies to avoid the ACA marketplace. If that leads to decreased enrollment, it could cause problems down the road because the marketplace “depends on healthy people signing up.”

Despite the focus on marketplace premiums, Oberlander emphasized that a small percentage of people – about 10 million of the country’s 319 million population – get insurance there. Most of the rest are insured through Medicare, Medicaid or employer-sponsored private plans. Premium increases for employer plans have been modest, but a trend toward higher deductibles had begun before the ACA was enacted, he said.

On the plus side, Oberlander said the ACA has reduced the number of uninsured people by about 20 million. Problems in the marketplace could be helped by extending several policy measures, scheduled to expire at the end of the year, that protect insurance companies from high losses.

“But it’s very hard in this environment to get Congress to agree on some common sense things that would stabilize it,” Oberlander said. “It’s a self-fulfilling prophecy. You don’t adopt things, and things get worse.”