Health insurance in Alaska
- Alaska opted to use the federal health insurance marketplace for exchange enrollment.
- Open enrollment for 2020 coverage in Alaska has ended, although people with qualifying events can still enroll or make changes to their 2020 coverage. The next open enrollment window beings November 1, 2020, for plans effective in 2021.
- Short-term health plans in Alaska can now have initial plan terms up to 364 days.
- Two insurers – Premera and Moda – offer on-exchange coverage.
- Alaska adopted the ACA’s Medicaid expansion in 2015. More than 48,000 people have coverage under the expanded eligibility rules.
- Alaska defaults to federal short-term health insurance rules.
- About 101,000 Alaskans were enrolled in Medicare at the end of 2019.
Alaska’s health insurance marketplace
Alaska’s health insurance exchange is run by the federal government, and residents enroll via HealthCare.gov. The state refused federal funding to evaluate and implement a marketplace, and was one of the first states to announce it would leave responsibility for its marketplace in the hands of the federal government.
The enrollment window for 2020 individual market plans has ended, although residents with qualifying events can still enroll or make changes to their coverage, depending on their circumstances. The next open enrollment window starts November 1, 2020, for plans effective in 2021.
Premera and Moda are the only insurers offering coverage in Alaska’s individual market for 2020.
Read our full overview of the Alaska health insurance exchange.
Gov. Bill Walker expanded Medicaid
Alaska decided against Medicaid expansion for 2014, and a Kaiser Family Foundation study estimated 30,000 Alaska residents were excluded from coverage as a result. But Gov. Bill Walker took office on Dec. 1, 2014, and made Medicaid expansion a priority in his first months.
On July 16, 2015, Walker used his executive authority to expand Medicaid on his own and Alaska Medicaid expansion took effect September 1, 2016.
From late 2013 through September 2019, enrollment in Medicaid/CHIP had grown by 80 percent. The state maintains a page that shows details about Medicaid expansion; as of November 2019, there were 48,150 Alaska residents covered under the ACA’s expanded Medicaid eligibility rules.
Read more about Medicaid expansion in Alaska.
Short-term health insurance in Alaska
Alaska does not have state-specific regulations pertaining to the duration of short-term health insurance plans, so the state defaults to the federal short-term rules. Insurers are allowed to offer short-term plans with initial terms up to 364 days and the option to renew for a total duration of up to 36 months.
Read more about short-term health insurance in Alaska.
Obamacare’s impact on Alaska
While the ACA is credited with a sharp decline in the uninsured rate across the nation, the impact in Alaska started out more modest. Alaska’s uninsured rate dropped 2.8 percent during 2014 open enrollment, from 18.9 percent to 16.1 percent.
But then Alaska expanded Medicaid in September 2015, nearly two years after many other states had implemented Medicaid expansion. And the uninsured rate in the state had dropped to 12.6 percent by 2018.
Alaska and the Affordable Care Act
Alaska’s three-member U.S. Congressional delegation voted 2-1 against the Affordable Care Act, which was signed into law in 2010. Sen. Mark Begich, a Democrat, was alone in supporting the ACA. Sen. Lisa Murkowski and Rep. Don Young, both Republicans, voted no. Former Gov. Sean Parnell opposed the overall ACA and spoke out strongly against a state-run exchange.
Sen. Dan Sullivan, a Republican who has talked about the need to repeal and replace Obamacare, defeated Begich in the 2014 election, so the state’s entire U.S. Congressional delegation is Republican. All are opposed to the ACA, but Senator Murkowski famously joined GOP Senators Susan Collins (Maine) and John McCain (Arizona) in voting against a bill to repeal the ACA in 2017, effectively killing the ACA repeal efforts in the Senate.
Alaska is the only state that did not to apply for the $1 million exchange-planning grant that was available from the federal government. State legislators considered a state-run exchange in the 2011 and 2012 sessions, but didn’t pass a bill either year. Parnell announced in July 2012 that the state would default to the federally facilitated exchange.
Initially, Alaska did not adopt Medicaid expansion. Governor Bill Walker, an Independent, took office on December 1, 2014, and announced his intention to expand Medicaid within his first 90 days in office. Though it took a little more time, he succeeded and the state expanded Medicaid on September 1, 2015.
Does Alaska have a high-risk pool?
Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including Alaska. This meant that medical history was an important component of eligibility for a private individual plan, and people with pre-existing conditions often found themselves unable to purchase coverage, or only able to get a policy that excluded pre-existing conditions.
The Alaska Comprehensive Health Insurance Association (ACHIA) was created in 1993 to give people an alternative if they were unable to obtain individual health insurance because of pre-existing conditions.
As a provision of the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This reform largely eliminated the need for high-risk pools, but the pool is still operational, and serves as a way for disabled Medicare beneficiaries under the age of 65 to obtain supplemental coverage, as Medigap plans in Alaska do not have to make their plans available to enrollees under age 65.
But Alaska’s assessment on insurers to fund ACHIA is now used to fund the Alaska Reinsurance Program.
Medicare enrollment in AK
In Alaska, 86 percent of Medicare recipients qualify for coverage based on age alone, whereas the other 14 percent are on Medicare as the result of a disability. These numbers are very close to the 85/15 split nationwide.
Medicare spending per enrollee in Alaska – $6,846 on average – was the second-lowest in the nation in 2016.
Medicare Advantage is an alternative to Original Medicare, used by about a third of Medicare beneficiaries nationwide. But in Alaska, there are no individual Medicare Advantage plans for sale. Just 1 percent of Alaska’s Medicare beneficiaries have Medicare Advantage plans, and these individuals are enrolled in employer-sponsored Medicare Advantage coverage.
However, about 38 percent of Alaska Medicare enrollees select stand-alone Medicare Part D plans, which provide prescription drug coverage. Of all U.S. Medicare recipients, 43 percent have stand-alone Rx plans, although most Medicare Advantage enrollees also have Part D coverage, integrated with their Advantage plans.
Alaska health insurance resources
- AK Health Reform – An initiative providing research, data and analysis regarding the state of health care in Alaska.
- Denali KidCare
Alaska Comprehensive Health Insurance Association – created by the Alaska State Legislature to provide access to health insurance coverage to all residents of the state who are unable to obtain individual health insurance.
State-based health reform legislation
Here’s a summary of what’s happening at the state level in Alaska with regard to healthcare reform: