Pima County residents can expect more plan choices and little to no change in monthly premiums when signing up for health insurance under the 2019 Affordable Care Act.
Open enrollment for 2019 begins Nov. 1 and runs through Dec. 15. ACA plans sold during open enrollment begin Jan. 1, 2019.
More than 165,000 Arizonans got coverage through ACA plans, also known as Obamacare, according to the Arizona Alliance for Community and Health Centers. Arizona, like most states, sells plans on the federally facilitated marketplace — healthcare.gov
Most of those signing up qualified for federal subsidies to help them pay for the insurance, which is available to working-age adults who are not covered by health insurance at work or through another government program.
Nearly 25,000 Pima County residents enrolled in ACA plans last year, according to the Centers for Medicare and Medicaid.
This year, three providers will offer insurance plans to Pima County residents, up from just one last year.
The 2019 providers are Ambetter, which provides insurance through Arizona Complete Health, formerly Health Net of Arizona, a subsidiary of the Centene Corp. of St. Louis; Blue Cross Blue Shield of Arizona; and, for the first time, Bright Health.
Maricopa County will have four insurers selling plans on the marketplace. Cochise, Santa Cruz and Pinal counties are all solely covered by Blue Cross Blue Shield of Arizona.
Blue Cross Blue Shield of Arizona will offer plans in 14 out of 15 Arizona counties and will be the sole provider in all but two, said Jeff Stelnik, general manager at Blue Cross Blue Shield of Arizona. The insurer will have access to Tucson Medical Center, he said.
Bright Health, based in Minneapolis, is new to Southern Arizona and is partnering with the Carondelet Health Network to provide care at two Tucson hospitals, St. Mary’s and St. Joseph’s, as well as at Holy Cross Hospital in Nogales.
Pima County residents who enroll with Bright Health will also have access to care at Phoenix Children’s Hospital as well as the micro-hospital under construction in Marana, said Katrina Cope, the Arizona market lead for Bright Health. That facility is expected to open next year.
The company decided to offer plans in Pima County because there was only one insurer last year and “it was a really great opportunity to add competition and a different model for consumers in the market,” Cope said.
Bright Health also expects strong presence of those who guide consumers through the enrollment process, commonly referred to as navigators, assisters and brokers, to help drive enrollment, she said.
There are a few misconceptions swirling around the ACA.
First, the ACA is still law. Different this year, however, is the repeal of the tax penalty on uninsured individuals who do not sign up for health insurance.
The Congressional Budget Office estimates that 4 million Americans will drop their ACA coverage in 2019 because of the lifted penalty and that the number of uninsured people will increase by 13 million by 2027.
When healthy people decide to go without insurance, it increases the risk within the pool and adds to market instability, driving up costs of future premiums, said Daniel Derksen, associate vice president for health/equity outreach and interprofessional activities for the University of Arizona Health Sciences.
The second misconception has to do with short-term plans, according to Allen Gjersvig, director of navigator and enrollment services for the Arizona Alliance for Community Health Centers. They are not the same as qualified ACA plans, he said.
Short-term plans provide temporary health insurance during unexpected gaps in coverage and do not meet the minimum essential coverage requirements under the ACA, Derksen said.
“We don’t want people to think they are equivalent,” Gjersvig said. “The consumer needs to do their due diligence, to check out what it does cover, but also what’s excluded.
“The claim is that it gives people more choices and it’s more affordable,” Derksen said, but if you’re among those who get in an accident, get a devastating disease or get ill outside the duration of the plan, then you’re out of luck.
Medical costs used to be top reason for individual or family bankruptcy, he said. “This is kind of a return to the days before the ACA,” Derksen said.
Third, many people think health insurance is too expensive, so they don’t try and shop around to find the deal that’s best for them, Gjersvig said. He encouraged everyone to actively shop, even if you already have a plan, because of the new plans and prices available, and because your income might have changed since last year.
Nearly nine out of 10 people who get ACA coverage receive financial aid in the form of refundable tax credits to help lower their monthly premium, Gjersvig said. Yet “many people don’t know that federal subsidies are still available to them,” Blue Cross’s Stelnik said.
Sometimes, when people meet with assisters to enroll in ACA plans, they discover that they qualify for AHCCCS, the state’s version of Medicaid, Gjersvig said. It all comes down to: “The less you earn, the less you pay,” he said.
ACA plan previews show a 45-year-old nonsmoking man living in Pima County who makes $40,000 per year would qualify for monthly tax credits of $89, and his premiums would range from $235 and $406 a month.
A 26-year-old nonsmoking Pima County woman making $30,000 qualifies for $87 in tax credits a month. The cost of her premium options range from $142 to $263 per month.
ACA enrollment can get complicated. Local help is still readily available despite the fact that federal grants for those who assist people in enrollment were “curtailed substantially,” Derksen said.
If you decide you don’t need help enrolling, “Don’t just look at price, but also look at what hospitals are in the network and what doctors and the premium cost,” recommends Michal Goforth, executive director of the Pima Community Access Program.
Gjersvig stressed, “If you don’t actively shop, you could be hurting yourself.”