Twin State Residents Weigh Insurance Options

  • Eric Bunge, left, managing director at Northern Stage looks over a mask with Aaron Patrick DeClerk, a guest designer at the theater company on Nov. 3, 2017 in White River Junction, Vt. Bunge has been shopping for health insurance. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Staff Writer
Friday, November 03, 2017

West Lebanon — Some New Hampshire residents who are mandated by the Affordable Care Act to get health insurance are facing such steep increases that they are likely to settle for more limited plans or even forgo coverage altogether.

Open enrollment season — the period when people can start selecting health insurance plans on the individual market for the coming year — kicked off on Wednesday, and residents in Vermont and New Hampshire found themselves in contrasting situations.

While premiums for Vermont plans purchased on the individual market, including those available through Vermont Health Connect, are going up, state regulators have kept increases to the single digits.

In New Hampshire, on the other hand, residents have fewer plans to choose from this year, and about 24,000 residents who receive no help through federal subsidies will see an average increase of 52 percent in health insurance premiums, according to the state’s insurance department.

Etna resident Eric Bunge, managing director of Northern Stage, is among them. He’s shopped for insurance and found nothing but plans that he considers unaffordable for three people in his family. In fact, he’s thinking of going without coverage.

“I’m ready to take my chances,” he said.

Some changes, however, will affect people in both states. As premiums go up, those who qualify for subsidies in both states are expected to see a boost in assistance. In addition, this year, there is a shorter open enrollment period, which ends on Dec. 15, rather than Jan. 31. There also is uncertainty on the federal level about whether the Trump administration will eliminate the “individual mandate” — Obamacare’s requirement that all people get health insurance — and about the impact of his order to end federal subsidies to insurance companies that help them lower insurance costs for low-income people.

Amy Finkle, patient navigator manager and new patient coordinator manager for Ammonoosuc Community Health Services, which has a clinic in Woodsville, said she already has heard from some people who may opt out of insurance coverage due to New Hampshire’s premium increases.

People who have called Finkle seeking assistance with re-enrolling in an exchange plan for 2018 are “a little bit shocked by the pricing,” she said.

She advises people in that situation to come in and update their income information, rather than doing nothing, which would mean they automatically would be enrolled in the 2018 plan most similar to the one they’ve had in 2017.

“Just updating your application does change things a little bit,” she said.

Finkle also has been fielding calls from Minuteman Health customers who will need to find new plans through New Hampshire’s other participating insurers Ambetter, Anthem Blue Cross Blue Shield or Harvard Pilgrim.

If none of those options work, a New Hampshire resident may have better luck going directly through an insurance company or broker, she said. That might mean enrolling in a plan that doesn’t meet ACA requirements and therefore subjects the person to possible penalties.

“We’re obviously restricted with what we do here with the platform of healthcare.gov,” she said. “You can go out and shop.”

Bunge consulted with an A.B. Gile insurance broker for several hours this week, but was unable to find coverage for his family.

“There are no affordable options,” Bunge said. “We’re faced with a very difficult situation and it is just so sad and disappointing.”

To cover himself, his wife, Gayle, who is self-employed, and their daughter Jayne with the same high-deductible, bronze-level Anthem Blue Cross Blue Shield plan in 2018 that they’ve had in 2017, Bunge is looking at an increase of $700 per month, or about 64 percent.

That increase will bring insurance for the family to nearly $1,800 per month, just for premium costs; not including their deductible or out-of-pocket expenses and not including the cost of health care coverage for an older daughter who is attending college in Minnesota.

Bunge said he hears concerns that a single-payer health care system would bankrupt the country, but he said the “current system is actually bankrupting our family.”

The family earns more than $100,000 annually — 400 percent of the federal poverty level — which disqualifies them for tax credits or subsidies when purchasing health insurance on the exchange. It also disqualifies them from financial aid for college tuition for their daughter Kelley and, Bunge said, their daughter Jayne also will be heading off to college next year.

Bunge said he plans to look into purchasing a high-deductible plan that does not include the ACA required “minimum essential coverage,” but doing so will mean they will be out of compliance with the individual mandate, which requires people to have adequate health insurance or pay a penalty.

“We’ll pay the penalty, or we won’t,” Bunge said, referring to President Donald Trump’s promise to eliminate the penalty, which at the moment is still in effect.

In Vermont, the Green Mountain Care Board held premium increases to the single digits, an average of 9.2 percent for Blue Cross Blue Shield of Vermont plans and 3.5 percent for MVP.

“Vermont hasn’t had any double-digit increases in any year,” said Sean Sheehan, the state’s deputy director of the Health Access Eligibility & Enrollment Unit of the Department of Vermont Health Access.

Certified navigators and in-person assisters do not charge for the assistance they provide, but they are getting harder to find in some cases. There are no in-person assisters in Sullivan County listed on the healthcare.gov website. As grant funding for this assistance has disappeared, the role has fallen to care coordinators at health care clinics that prioritize the service. In the Upper Valley, in addition to Ammonoosuc, clinics that offer such assistance include Little Rivers Health Care, with offices in East Corinth, Wells River and Bradford, Vt.; Valley Health Connections, a partner of Springfield (Vt.) Medical Care Systems; Gifford Medical Center in Randolph and Good Neighbor Health Clinics in White River Junction.

Vermont has more than 150 assisters and navigators, said Sheehan, of the Vermont Department of Health Access. There are about 50 in-person assisters in New Hampshire, a number that decreased after the 2015 enrollment period when federal funds to support additional assisters were eliminated, said Stephanie Pagliuca, director of the recruitment center at Bi-State Primary Care Association.

Though the online tools have improved since the marketplaces first opened in 2013, people still need in-person help when they get confused about how to find suitable health care coverage, said Lynn Raymond-Empey, the executive director of Valley Health Connections, which provides in-person assistance to people in Windsor and Windham counties.

“It’s a very busy time,” Raymond-Empey said. “We spend a lot of time with folks who have normal life complications.”

People come to Valley Health seeking assistance in calculating their income, particularly if they’re self-employed, working several jobs or have undergone a job transition, Raymond-Empey said. In other cases, people have aged out of one type of insurance coverage and need help moving to another, she said.

So far, however, Finkle said, call volumes seem down from last year.

“Last year, I had many, many more cold inquiries,” she said of people seeking information about the online marketplace, wanting to preview plans and prices and determine whether they qualified for tax credits.

In addition to the increase in costs this year, Finkle said she does expect the shorter enrollment period — about half the length of last year’s — will affect enrollment numbers.

Overall, New Hampshire is expecting to see participation in the marketplace drop.

“By year end 2018, the individual market will lose 5,300 to 13,200 members due to the premium rate increases, the market withdrawal of Minuteman and other product offerings, and the weakening of the individual mandate,” according to a September report by Gorman Actuarial, commissioned by the N.H. Insurance Department.

In Vermont, however, officials are not expecting a drop in participation this year.

Brokers and assisters also pointed to uncertainty coming out of Washington as a source of confusion for all involved this enrollment season.

In addition to sorting out what coverage will best match their personal needs, those who buy insurance on the exchanges also are trying to understand what federal changes — including President Trump’s plans to eliminate cost-sharing reduction payments and the individual mandate — will mean for them.

Though Trump issued an order eliminating the cost-sharing reduction payments to insurers, the companies are still required to offer reduced-cost plans. This year, New Hampshire rates reflect the lack of cost-sharing payments, said Danielle Barrick, a spokeswoman for the N.H. Insurance Department. Vermont’s Green Mountain Care Board, however, prevented insurers from increasing 2018 rates to adjust for the decrease in federal support. The future beyond 2018 is less certain.

“Everybody’s nervous and worried about what’s going to happen,” said Raymond-Empey. But, “nothing fixes anything, nothing changes anything. We’re just kind of going along here.”

Information about open enrollment can be found online at healthconnect.vermont.gov and healthcare.gov.

Little Rivers Health Care is offering drop-in information sessions in the coming weeks. A care coordinator will be at the Blake Memorial Library in East Corinth on Nov. 29 from 3 to 4 p.m. and on Dec. 7 from 9 to 10 a.m.; at Baldwin Memorial Library in Wells River on Nov. 15 from 2 to 5 p.m. and Nov. 22 from 2 to 4 p.m.; and at the Bradford (Vt.) Public Library on Nov. 29 from 6 to 8 p.m.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.