Posted: November 27th, 2016 | By: John Murawski
Professor Mark Hall , director of the Health Law and Policy Program, is quoted in the following story, “NC residents who don’t qualify for federal insurance subsidies feel the sting of rate increases,” by John Murawski and published in the Raleigh News and Observer on Nov. 25, 2016.
Following is an excerpt:
In some states, health insurance that is not purchased thru the Affordable Care Act exchange is more affordable than ACA marketplace plans, even though all the plans are ACA-compliant, offering federally mandated benefits and cover pre-existing conditions.
In North Carolina, however, plans sold off the ACA exchange are not markedly cheaper.
What’s more, the number of off-exchange insurers here is the lowest in years, according to the N.C. Department of Health Insurance. The agency lists just four individual insurers, in addition to Blue Cross, that are licensed to sell individual insurance in 2017.
Individual coverage purchased off-exchange, even if identical to an ACA marketplace plan, does not qualify for federal subsidies.
Blue Cross will be the only insurer offering ACA plans in all 100 counties in the state. Those plans can be purchased through Healthcare.gov. Off the exchange plans can be purchased through an insurance agent or directly from the company.
However, other insurers are not marketing their off-exchange individual plans in North Carolina, so that customers may have trouble finding information. One of the insurers licensed to sell individual policies in the state, National Foundation Life Insurance Co., does not list pricing and benefits details online and did not respond to phone and email inquiries last week.
One reason that insurers offer off-exchange individual insurance is to maintain their federal eligibility to reenter a state’s ACA market. Insurers that offer no products off the ACA exchange have to wait five years to get back into the federal market to sell subsidized health insurance.
Cigna Health and Life Insurance Co. is offering a statewide plan with a $6,400 individual deductible, and monthly premiums in the state’s 16 rating areas. Aetna offers individual plans in about half the state’s 100 counties, with a $5,700 individual deductible in the Triangle.
Cigna will charge $609 a month for a 50-year-old non-smoker in Wake County, whereas Aetna will charge a 50-year-old nonsmoker in Wake County $561.31. Blue Cross offers multiple options in Wake County, ranging from $571.77 a month to $876.50 month for a 50-year-old non-smoker.
Off-exchange plans make sense only for people with enough income to pay the unsubsidized fees. The plans are known for attracting people with serious medical expenses.
“If you’re thinking off-exchange, who’s going to be willing to pay those prices?” said Mark Hall, a law professor and health insurance expert at Wake Forest University. “Well, maybe people who really need to use it.”