Missourians who buy health insurance plans on the Affordable Care Act marketplace will likely see higher premiums during this season's enrollment as all but one carrier in the state is raising its average rates.
Only one carrier, Blue Cross and Blue Shield of Kansas City, reported that its prices are going down, on average. Some carriers, including Cox Health Systems Insurance Company and the Celtic Insurance Company, are hiking rates by an average of 20% or more for marketplace customers.
The individual market, sometimes called the Affordable Care Act or Obamacare Marketplace, is where people who don’t receive government-based or employer-sponsored insurance can buy health plans.
Open enrollment started earlier this month. People who need coverage by Jan. 1 have until mid-December to sign up for plans.
According to the nonprofit health policy analysis organization KFF, the average benchmark plan in the state will cost around $600, a 24% cost increase compared with the year before.
Additionally, some people who make more money are no longer eligible for coronavirus-era tax credits that have helped lower the out-of-pocket costs for some customers. That means certain Missouri residents could pay hundreds more each month than they are used to for the same health plans.
The fight over extending these “enhanced” tax credits is at the heart of the federal government shutdown, now in its second month and the longest such shutdown in the country’s history.
“The most important thing we want Missourians to know is this — do not give up on getting coverage,” said Missouri Department of Commerce and Insurance Director Angela Nelson in a news release. “Health insurance is too important.”
Insurance customers and professionals who help sign people up for coverage say they’ve experienced confusion and frustration navigating the price hikes and changing tax subsidies.
Jackie Dana, a freelance writer in St. Louis, saw the price of her health plan double when she went to sign up for insurance on heathcare.gov earlier this month.
“It's all just a guessing game,” she said.
Dana’s annual income hovers around what is now the cutoff level for receiving tax credits for plans, or 400% of the federal poverty level. Her expensive diabetes medication is one of the reasons coverage is vital to her.
“The prescription costs and some of the healthcare costs are so hard to navigate,” she said. “Should I just downgrade to a Bronze plan because my insurance is going to still cover my prescriptions well enough? Or am I going to be paying a ton out of pocket for my prescriptions if I do that? Am I better off staying in the better plan that's twice as expensive?”
Because she’s a freelancer, it’s possible she could make more money next year from side gigs and extra work than she anticipated, she said.
That would put her over the cut-off point for tax credits and force her to pay hundreds of dollars in subsidies back to the government, a risk she doesn’t want to take .
“It’s tricky,” she said. “All of that extra money is going to be eaten up by my health insurance premium. So in some ways, I would be better off not making that extra money [at all].”
As a result, she decided not to use the tax credits. But that means she is paying even more.
Confusion and frustration
The federal shutdown and the changes in tax credits for certain customers have made this year particularly confusing for people who buy individual market plans, said Jamie Murray, a health worker who helps patients in southwest Missouri sign up for ACA health plans.
She emphasizes that even during the federal shutdown, the marketplace is open for business and people can still sign up for plans.
However, Murray said those people should expect some sticker shock.
“Unfortunately, what people are also seeing is the humongous increase in premium costs, which feels extremely overwhelming for a lot of new consumers to the ACA,” Murray said. “So I understand why people are anxious and taking a step back, because I've seen premiums go up 100% or more for the patients I’ve helped this week.”
She said there’s been some confusion about whether people can still receive tax credits to help pay for plans. While the expanded credits for people who make more than 400% of the poverty rate are gone (at least for now), subsidies are still available for those who make less than that amount.
“We still have the premiums that have been there and always have been there,” she said. “They're just not as sufficient as they have been because of those other two covid era subsidies ending.”
Randolph County Caring Community Partnership Director Patti Hendren said many customers in northeast Missouri have seen their monthly health premium costs increase by $200 to $300 a month.
“Some individuals are choosing Bronze plans with more affordable premiums but higher deductibles,” Hendren said.
Some rural physicians and clinics are no longer accepting patients who use marketplace health insurance plans at all: “This has forced consumers to travel to larger communities to find providers who will accept their coverage,” Hendren said.
The increase in health costs comes at a time of rising prices for utilities and food. The freeze on federal food benefits is also squeezing families who may need to make tough decisions about what to buy and what to go without.
Even if a person needs to buy the cheapest plan with a high deductible, some coverage is better than no coverage, Murray said.
No one plans on experiencing a car accident, a cancer diagnosis or other catastrophe, she said.
“This year alone, I experienced a life threatening emergency, and you can't plan for that,” Murray said. “I had met my deductible…and I didn't pay anything for what could have been hundreds, thousands of dollars in bills.”
