END OF 2018 OPEN ENROLLMENT PERIOD (Connecticut & Maryland)

Time: D H M S

OE5

Believe it or not, the original core focus of ACASignups.net was...wait for it...to track how many people are Signing Up for the ACA. Hard to believe, I realize.

Anyway, I have my first hard data point of the batcrap insane 2018 Open Enrollment Period, and it's a surprisingly positive one:

Enrollments in health insurance through the state’s health exchange was robust on the first day of open enrollment Wednesday, with more people signing up for insurance than last year, officials said Thursday.

Advocates and others had expressed concern that consumers would be confused by political wrangling and policy changes to the Affordable Care Act from the administration of Pres. Donald Trump that led to last-minute rate increases and a severe decrease in marketing dollars for the program.

But exchange officials reported that enrollments under the law, known as Obamacare, were up 70 percent to more than 1,800 compared with 1,055 on the first day a year ago. About 150,000 people signed up for private insurance on the exchange in the state last year and more enrolled directly through insurers.

Until today, I operated under the assumption that my home state of Michigan was among the 18 states which took the "Silver Load" approach to dealing with the Cost Sharing Reduction (CSR) cut-off by the Trump administration. Reviewing the SERFF rate filings of the various carriers participating in the individual market, it looked like most of them were loading the CSR cost onto both on and off-exchange Silver plans. I didn't check every single carrier, but that seemed to be the trend, so I filed the state under "Silver Load".

HOWEVER, earlier today, commenter "Cayo" chimed in to say:

I'm signing up for a plan off the exchange with Priority Health in Michigan. ON-Exchange, the plan is $365 a month, but off exchange (directly from their website), the price is $300 per month. I don't qualify for a subsidy, but it's still cheaper than my 2017 plan with BCBSM. That was the Multi-State Plan in Region 7 with Dental and Vision.

MAJOR UPDATE / MEA CULPA: 

Hey there, I called again and I was able to talk to a more knowledgeable agent who found out what the issue was and was able to enroll me in a plan!

Apparently, the Marketplace renewed automatically my application based on my 2016 income, which was enough to receive a tax credit in 2017, but is no longer enough to receive one in 2018.

Luckily, my income has increased since then, so I reported the change and was able to get a credit applied to the premiums

Still need to send copy of my green card for verification, but I can use the tax credit immediately

So I'm not sure why the person I talked to earlier today told me the rules had changed

Sorry for the confusion

OOF. OK, this pretty much torpedoes the entire basis of this blog entry. I'm going to leave it up in the interest of letting documented immigrants know that they ARE eligible to enroll AND for tax credits, but it sounds like the original concern may be unwarranted after all.

No one has been promoting the Silver Switcharoo option (in states which allow it) louder or more emphatically than I have for the past few weeks.

To summarize (again), this is where someone whose household income is too high for them to qualify for ACA tax credits (400% of the Federal Poverty Line) chooses an ACA-compliant off-exchange Silver plan instead, which is either identical or nearly identical to the same on-exchange policy in every way except that the additional CSR load hasn't been tacked onto it.

Here's a perfect example found by Louise Norris...ironically, this is via Priority Health here in Michigan, which (until today) I thought was a "Silver Load" state, not "Silver Switcharoo". I'll have to do some more research to be sure, but it sounds like at least one MI carrier (Priority) is going full Switch:

#1: The 2018 Open Enrollment Period is only half as long as usual in most states!

  • In the other 11 states (+DC), the deadline to enroll for 2018 coverage is later...but the final dates range from Dec. 22nd (CT) to as late as Jan. 31 (CA, DC & NY).

#2: BOTH types of Tax Credits/Subsidies ARE STILL AVAILABLE for those who qualify!

UPDATE: It looks like this issue may be limited to a single carrier in New Mexico; I've changed the headline and graphic accordingly...but it might be an issue in other states as well; if so I may have to change it back again...

Fantastic (if migraine-inducing) scoop by Susannah Luthi of Inside Health Policy (paywall):

Insurers That Filed Wrong Rates Told By CMS They Can't Sell Plans Through Mid-November

An issuer whose final CMS-approved rates don’t account for the loss of cost-sharing reduction payments is being told by the agency that they won’t be able to sell plans until healthcare.gov data is refreshed– even though this would mean the carriers are even more crunched for time to sell their plans during the shortened open enrollment period.

Last week I gave a very rough, back-of-the-envelope projection of perhaps 9.5 - 10.0 million Qualified Health Plan (QHP) selections during the 2018 Open Enrollment Period, which starts tomorrow. As I repeatedly emphasized, this wasn't based on any deep-in-the-weeds statistical analysis, because the one-two punch of the GOP's farcical "repeal/replace" efforts combined with the Trump Administration's "let Obamacare explode!" sabotage efforts have managed to botch things up so badly that I didn't see much point in expending the effort this year. Besides, others, such as Obama Administration Chief Marketing Officer Joshua Peck have already done part of this work for me:

Considering how absolutely obsessed the Trump Administration is about repealing the ACA, this new official report from Trump's Assistant Secretary for Planning and Evaluation (ASPE) seems like a strange way of showing it.

The very first bullet starts off ripping on the 37% average rate hike on benchmark Silver plans...

Benchmark Premiums: The average monthly premium for the second-lowest cost silver plan (SLCSP), also called the benchmark plan, for a 27-year-old increased by 37% from plan year 2017 (PY17) ($300) to PY18 ($411).

Premium Growth: For the first time, annual growth in the average monthly premium available to a 27- year-old for the SLCSP, at 37%, outpaced that of the lowest-cost plan (LCP), at 17%.

Of course, there's pretty obvious reason for that: Trump's cut-off of Cost Sharing Reduction (CSR) reimbursement payments. The ASPE report does go into this, but not until Page 6. Meanwhile, it's immediately undermined anyway (at least regarding subsidized enrollees) in the very next bullet:

With the 2018 Open Enrollment Period coming up just 5 days from now, it's time to put this to bed: After 6 months of painstaking research and analysis, I've compiled a comprehensive analysis of the weighted average rate changes for unsubsidized ACA-compliant individual market policies in 2018, including both the on- and off-exchange markets. It's already been confirmed by a different analysis by healthcare consulting firm Avalere Health, which used a completely different methodology to arrive at the exact same conclusion: The national average increase is between 29-30%, ranging from as low as a 22% average premium drop in Alaska (thanks to their successful reinsurance program) to as high as a painful 58% increase in Virginia.

As noted earlier today, I've now managed to plug 48 states (plus DC) into my 2018 Rate Hike Project spreadsheet. This leaves just two states missing: New Hampshire and Texas. I'm still waiting to clarify some things for each, so this analysis could still change, but I really want to wrap this up, so here's what I have for New Hampshire right now:

When I first ran the numbers for New Hampshire's requested 2018 rate increases, it seemed pretty straightforward: 3 carriers on the individual market. 2 listed rate changes assuming CSRs would be paid; one assumed they wouldn't. This gave the following:

Cut 'n dry, right? Guess again: An August press release from the NH Dept. of Insurance stated:

With 43 states accounted for, Open Enrollment itself looming just 6 days from now and HealthCare.Gov's window shopping tool now open for business anyway, there aren't likely to be too many surprises left for my 2018 Rate Hike project. For that matter, healthcare consulting firm Avalere Health just published their own analysis which confirms my own closely: They have the 2018 on exchange average increase at 29.1%, while I currently have the combined on & off-exchange average (for 43 states) at 29.2%.

Still, I don't like loose ends, and those 8 missing states are bugging me, so I still want to fill them in for completeness' sake. The only big state remaining is Texas, but I'm also missing Alabama, Hawaii, Iowa, Missouri, New Hampshire, Oklahoma and Wyoming.

As regular readers know, I've spent the third consecutive summer/fall painstakingly analyzing both the requested and approved unsubsidized (full-price) rate increases on the individual market for 2018. My track record the prior two years has been pretty good:

Let's suppose that you and your spouse were 39 years old last fall, and you have two young children. None of you smoke, and you live in Oakland County, Michigan. Let us further suppose that you decided to enroll your family in a standard Silver policy via the federal ACA exchange, HealthCare.Gov. Blue Cross Blue Shield of Michigan is the biggest carrier in the state, and Blue Care Network is their HMO division, so you decide to go with them.

How much of a tax credit will they receive, and how much would they end up paying for 2017 at different income levels after applying tax credits?

In 2017, the Federal Poverty Line in the 48 contiguous states for a family of four $24,300. Let's plug in some different incomes and see where they fall on the FPL scale:

 

Several of the states operating their own ACA exchanges have already had their 2018 Window Shopping tools up and running for several weeks now, including Covered California, Your Health Idaho and the Maryland Health Connection, so this really shouldn't be that big of a deal, but given the insanity and uncertainty surrounding this years' Open Enrollment Period and especially the fact that HealthCare.Gov is responsible for 39 states (while being operated by the federal government under the thumb of an openly-hostile Trump Administration), it's pretty important news regardless.

In any event, HealthCare.Gov's 2018 Open Enrollment Period Window Shopping tool is now live.

 

On November 10, 2016, at 4:30 in the morning, I was still in a bit of a dazed state trying to absorb the reality that a racist, misogynistic, xenophobic con-artist sexual predator moron was about to become the next President of the United States. We were 9 days into the 2017 Open Enrollment Period, and I realized that there was absolutely no way of knowing what sort of impact the election results might end up having on how many people would sign up for coverage.

My original, pre-OE4 projection was that it would come in anywhere between 13.5 - 14.0 million people, but I quickly realized that I'd have to drastically alter my thinking. How drastically? Well, I actually posted the following to give an idea of how deep into the unknown we were:

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