There is recent news about the Affordable Care Act that another private insurance company is pulling out of some exchanges. Can you start by telling us a little about that?
Mellody: Aetna announced this week that it was withdrawing from the Obamacare exchanges in 11 of the 15 states it had been doing business – Arizona, Florida, Georgia, Illinois, Kentucky, Missouri, North Carolina, Ohio, Pennsylvania, South Carolina and Texas – becoming the third major insurance company to scale back its offerings in the face of financial losses. This comes on the heels of United Healthcare’s announcement that they will be exiting most Obamacare exchanges in 2017, and Humana’s announcement that they are pulling out of nearly 1,200 counties next year.
Why are these companies pulling out of some of the exchanges?
Aetna is citing the losses that it has incurred when offering coverage through the Affordable Care Act markets. The company says it has lost $430 million in its individual policies unit since it started participating in the ACA exchanges in January 2014. Why? Aetna asserts that its 838,000 exchange customers have turned out to be sicker and costlier than it had initially expected. The other insurers who have pulled back from some exchanges have cited similar financial challenges.
What will happen as a result of these moves?
No one has a crystal ball, but a few things are clear. As a result of Aetna’s decision, 20% of the company’s 838,000 Obamacare participants in 536 counties will be forced to sign up for other Obamacare plans or purchase individual insurance outside of the exchanges once open enrollment begins later this year. This could mean that patients may lose their preferred doctors and hospitals if they sign up for plans that don’t include those providers in their network coverage.
However, it is important to note that a large majority of states will continue to have multiple insurers participating in their ACA exchanges next year. The impact of these moves is expected to be felt most acutely in rural areas, particularly in the Southern united states. It looks like about one in four counties will end up having just one insurer on the exchange next year. Most of these counties are sparsely populated, though, so relatively few people will be affected. A few states – Alabama, Alaska, Oklahoma and South Carolina – are expected to have just one insurer in the entire state in 2017. But, as I said, people who live in more densely populated areas, especially cities, will continue to have several insurer options on the exchange.
Will some people be hit in the pocketbook in these states and counties? And if so, what should people be considering?
Again, it is important to reiterate that most people will still have multiple exchange plans to choose from, even if they have to switch plans as a result of their current provider pulling out of their exchange. Nearly two-thirds of those insured through the ACA are expected to have the same number of health insurance providers in 2017, with one-third having at least 3 insurers to choose from.
There will be people who are impacted. For the most part though, people living in these areas are getting financial assistance to purchase their coverage, so as long as there is one exchange insurer in their county or state, they will still be able to receive subsidies and continue to pay around the same amount they do now, even if they do need to change plans.
So, while analysts are forecasting that the premium for an average plan is expected to rise by 9% in 2017 to a monthly payment of $281, most ACA plan members will continue to receive the credits and subsidies to help pay for their coverage. The U.S. Department of Health and Human services (HHS) reported that 85% of Obamacare plan members received tax credit subsidies and paid only $4 extra per month in 2016.
Do you have any advice for our listeners as we look ahead to next year?
The best thing you can do is to keep yourself informed. If you currently get insurance through ACA exchanges, go to healthcare.gov. From there, you will be directed to the appropriate exchange, and you will be able to learn what your options are. We will not know for sure what the 2017 plan offerings will be until November 1, when open enrollment starts, but you can get advice and assistance from people on healthcare.gov to prepare for next year. Even if like your current plan, it is always a good idea to shop around and compare it to others so you can make the most informed choice for your personal and financial health.