Federal health officials are predicting little growth in sign-ups as Year Three of open enrollment for the health insurance exchanges begins Sunday. U.S. Health...

Federal health officials are predicting little growth in sign-ups as Year Three of open enrollment for the health insurance exchanges begins Sunday.

Sylvia Burwell

Sylvia Burwell

U.S. Health and Human Services Secretary Sylvia Burwell said the administration expects that exchange enrollment nationally will reach about 10 million people by the end of 2016, up from 9.9 million announced in late June of this year.

More than 540,000 Georgians signed up for coverage in 2015 in the health insurance exchange, which was created under the Affordable Care Act. Dante McKay, state director of Enroll America, said Tuesday that he hopes Georgia at least equals that total or exceeds it for 2016.

The first two years of exchange enrollment in Georgia harvested “some low-hanging fruit,’’ McKay said. The remaining uninsured, he added, “may not be as easy to reach.”

Groups that will draw extra focus for enrollment in the state include young adults, Latinos and African-Americans, McKay said.

Open enrollment runs through Jan. 31. Consumers must sign up by Dec. 15 to have coverage that starts Jan.1.

One enrollment wild card is the increase in the tax penalty for not signing up for coverage.

Unless exempted, people who remain uninsured next year will be subject to a penalty of $695 for an individual, or 2.5 percent of household income — whichever is greater. That’s up from the 2015 penalty: $325 or 2 percent of income, whichever is greater.

“Part of our role is educating consumers about the penalty,’’ McKay said.

Healthcare CostThis year was the first time the IRS collected the penalties, deducting them from taxpayers’ refunds for the 2014 tax year in most cases, the Associated Press reported this month. Some 7.5 million households paid penalties totaling $1.5 billion, an average of $200 apiece, according to preliminary IRS data.

Meanwhile, many of those with current exchange coverage will see increases in their premiums.

HHS says there will be a 6.1 percent increase for Georgia’s second-lowest-cost silver plans in 2016. That hike is lower than the national average of 7.5 percent for the 37 states, including Georgia, that have their exchanges run by the federal government.

The metro Atlanta market will see a 4.7 percent increase in that benchmark plan, also lower than other major markets studied.

These increases do not take into account the subsidies that lower the monthly costs for the majority of exchange consumers. Nationally, about 8 in 10 individuals who selected a 2015 exchange plan qualified for financial assistance, and the average subsidy for those who qualified was $270 per month, HHS said.

Consumers should shop around among health plan offerings “to ensure they are choosing the plan that best meets their health needs and their budget,’’ said Cindy Zeldin of Georgians for a Healthy Future.

“In most regions, individuals who return to exchanges to shop for coverage will likely be able to keep premium increases low,” said Elizabeth Carpenter, vice president at Avalere, a consulting firm. “This is especially true for individuals receiving subsidies, who are largely insulated from rate hikes, depending on the plan they choose.”

Cindy Zeldin

Cindy Zeldin

Due to increased funding, Georgia will have more insurance “navigators“ and “assisters’’ to help consumers sign up for coverage.

Zeldin said this assistance “will continue to be essential in reaching the individuals, families, and communities who need help making sense of their options and understanding the enrollment process.”

According to a recent Kaiser Family Foundation report, Georgia has about 1.5 million uninsured people. Of that total, about 200,000 are eligible for Medicaid, and 400,000 more are eligible for subsidies in the exchange.

But 300,000 other Georgians are in what’s known as the coverage gap – having too much income to qualify for Medicaid, yet not enough to qualify for exchange subsidies.

The gap exists in the states, including Georgia, that have not expanded their Medicaid programs to cover more people. The Affordable Care Act calls for every state to expand Medicaid, but the U.S. Supreme Court has ruled that states are not obligated to do so.

For enrollment help, here’s a website that can assist consumers: https://www.getcoveredamerica.org/connector/

 


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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