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Georgia health insurance exchange / marketplace

GA enrollment beats expectations, but subsidies on the line for 415k pending King v. Burwell ruling

2016 rates – a second look

On June 1, released proposed rate increases of ten percent or more on their rate review tool.  The fact that the tool only shows proposed rate hikes that make it into double-digit territory has certainly been cause for some confusion (this article by Charles Gaba is a great explanation).

While there are quite a few Georgia plans that have requested rate increases of ten percent or more, the state has outside actuaries reviewing the rate proposals in an effort to lower them – a process that will take most of the summer.  And industry officials in Georgia note that “many plans” in Georgia have submitted 2016 rate increases under ten percent – but those don’t show up on’s rate review tool.

Time insurance company has some particularly eye-popping rate proposals for 2016, with premium increases in the neighborhood of 60 percent.  But it’s worth noting that Time/Assurant is selling its health insurance business, and has indicated that it will pull out of the individual market in 2016 if a buyer isn’t found by then.  So it’s possible that even if the rates are approved, they could be moot if the company doesn’t find a buyer for its health line of coverage.

2015 enrollment

At the end of 2015 open enrollment, 541,080 Georgians had signed up for qualified health plans (QHPs) through Fifty-five percent of Georgia enrollees were new to the marketplace in 2015. Various experts indicated that enrollment exceeded expectations. According to Kaiser, 50 percent of Georgians who were eligible to enroll through the marketplace have selected a health plan.

More than 350,000 of Georgia’s enrollees were from the Atlanta/Sandy Springs/Roswell metropolitan area. Only the Miami/Fort Lauderdale/West Palm Beach area had higher enrollment than the greater Atlanta area.

Ninety percent of Georgia consumers qualified for financial assistance to purchase coverage; the average among all states using the federally facilitated marketplace was 87 percent.

King v. Burwell

Unfortunately, those subsidies could be stripped away depending on the Supreme Court’s upcoming ruling on King v. Burwell.  The Court will issue their decision later this month, and if they rule that subsidies can only be provided by state-run exchanges, 415,000 people in Georgia would lose their subsidies.

Just for the latter half of 2015, that would amount to an average of $1,638 in higher taxes for each of those people, assuming they’re able to keep their coverage without a subsidy (the subsidy is a tax credit, which is why those enrollees would essentially just be paying more in taxes if the plaintiffs prevail in the King lawsuit).

Can you still sign up?

Open enrollment for 2015 has ended, but under certain circumstances, you may be able to get health insurance before the next open enrollment period starts in November.

  • If you have a qualifying life event, you are eligible for a special enrollment period. You have 60 days from the date of the event to sign up or change your coverage.
  • If you are a Native American, you can sign up through the marketplace anytime during the year.
  • If you qualify for Medicaid, you can enroll anytime during the year.

Otherwise, open enrollment begins again on November 1, for coverage effective January 1, 2016.

Insurers joining Georgia marketplace

Georgia consumers shopping for health insurance on the marketplace have nearly double the number of insurers to choose from in 2015 as they did in 2014. In addition, three companies — as opposed to one last year — are selling policies statewide. A health insurance expert at Georgia State University says the influx of statewide competition will help reduce disparity in premium costs seen among different regions of the state.

Nine insurers are participating in the Georgia health insurance marketplace for 2015, including four who are new to the exchange this year. The returning companies are Alliant Health Plans, Blue Cross, Humana, Kaiser Permanente, and Peach State Health Plans. The new entrants to the marketplace are Cigna, Coventry, UnitedHealthcare, and Time Insurance.

2015 premiums up just 1 percent

Georgians are currently paying an average of 1 percent more for health plans on the marketplace compared to 2014. The overall average is weighted and considers all metal tiers. The average cost of bronze policies is down 4 percent, the average cost of silver and gold policies is down 1 percent, and the average cost of platinum policies is up 33 percent.

Given that southern Georgia had some of the highest premium costs in the nation for 2014, the modest average increase is welcome news for the second year of Obamacare.

Facts and figures from 2014 enrollment

More than 316,500 Georgians enrolled in qualified health plans (QHPs) during 2014 open enrollment. That’s nearly 30 percent of the estimated 1,063,000 Georgians considered eligible to enroll in the insurance marketplace by the Kaiser Family Foundation.

Among Georgia residents selecting a QHP, 87 percent qualified for financial assistance, compared to 85 percent nationally. A report released in June 2014 by the U.S. Department of Health and Human Services showed the average monthly premium, after tax credits, for Georgia consumers was $54. Sixty percent of enrollees pay $50 or less per month after subsidies. Georgia’s $54 average is the second-lowest in the nation — after Mississippi, where the average monthly premium after subsidies is just $23.

Ten percent of Georgia residents selected a bronze plan (20 percent nationally), 73 percent selected a silver plan (65 percent nationally), 6 percent selected a gold plan (9 percent nationally), 9 percent selected a platinum plan (5 percent nationally) and 2 percent selected a catastrophic plan (2 percent nationally). Thirty-one percent of Georgia enrollees were between the ages of 18 and 34.

Background on the marketplace in Georgia

Georgia opted to use the federal health insurance marketplace, State government officials such as Gov. Nathan Deal and Insurance Commissioner Ralph Hudgens vocally opposed the Affordable Care Act. Hudgens implemented a requirement that navigators, who help consumers use the marketplace, pass the test that insurance agents are required to take. That requirement is much more stringent than required by the health care reform law, and Hudgens openly stated it was intended as obstructionism. At the end of its 2014 session, the Georgia Assembly passed a bill that prohibits establishing a state-run marketplace, disallows the use of taxpayer money for navigator programs, and forbids government employees from advocating for Medicaid expansion.

Georgia’s director of Enroll America, Dante McKay, said that lack of access to navigators hurt enrollment in rural Georgia counties in 2014. McKay also said the amount of federal funding Georgia received for navigators was among the lowest of all the states on a per uninsured person basis in 2013 — and the amount decreased in 2014.

Georgia has not expanded its Medicaid program. Gov. Deal has repeatedly said Medicaid expansion would cost the state too much, and the General Assembly passed bills that give it authority over any changes to the state’s Medicaid rules. By not expanding Medicaid, the state is leaving up to 282,000 low-income residents in a coverage gap — unable to qualify for either Medicaid or subsidies through the marketplace.

Georgia’s uninsured rate in 2014 was 19.1 percent; the national average was 13.8 percent.

Georgia health insurance exchange links

Georgia Watch

Georgia Health News