As of December 26 – with five weeks remaining in the 2016 open enrollment period – enrollment in private plans through the Georgia exchange had reached 511,826 people, including new enrollees and renewals. To put the total in perspective, enrollment the year before stood at 541,080 people at the end of the 2015 open enrollment period.
Open enrollment continues through January 31. Plan selections made by January 15 will have coverage effective February 1, while plan selections made in the second half of January will have coverage effective March 1. If the exchange already auto-renewed your plan for January, you can still return to the exchange and select a different plan with a February or March effective date.
The penalty for being uninsured will be significantly higher in 2016 than it was in 2014 and 2015. Given the sharp increase in the penalty, many residents – particularly those who qualify for premium subsidies – will find that for the same amount of money, they could fund several months of health insurance premiums instead of paying a penalty that gives them nothing in return.
Rate hike lower than national average
Healthcare.gov enabled browsing for 2016 plans on October 26, a week before the start of open enrollment. They also released a report showing average price changes for the benchmark plans in each state (benchmark plans can be different from one area of a state to another, since rates and plan availability vary by region). The benchmark plan is the second-lowest-cost Silver plan, but it can be a different plan than the one that held that spot the prior year.
Across the 37 states that used Healthcare.gov in 2015, the average benchmark premium increase for 2016 is 7.5 percent. In Georgia, it’s lower, at 6.1 percent. Kaiser Family Foundation did their own analysis using premiums for a 40-yer-old non-smoker in metropolitan areas across the country. In Atlanta, they found a slight decrease (-0.4 percent) in the benchmark premium.
The majority of the carriers that sell individual plans in the Georgia exchange requested rate increases of ten percent or more for at least some of their plans, and the state used outside actuaries to review the rate proposals in an effort to lower them. Industry officials in Georgia noted that “many plans” in the state submitted 2016 rate increases under ten percent, but those weren’t available to the public until rates were finalized.
For 2015, the average rate increase in Georgia was just one percent. For 2016, it’s considerably higher than that, but there are still some carriers with very modest rate hikes for 2016. I requested approved rate changes from the Georgia Office of Insurance and Safety Fire Commissioner; for plans sold in the exchange, the approved filings indicate the following average rate changes:
- Aetna Health: 17.3 percent
- Blue Cross Blue Shield of Georgia: 16.4 percent
- Cigna: 3.73 percent
- Harken Health Insurance (new to exchange for 2016)
- Humana: filing indicated two different approved “overall rate impacts:” 19.8 percent for HMO plans and 21.8 percent for POS plans (just slightly lower than the 19.9 and 21.9 percent rate increases that they originally proposed).
- Kaiser Permanente: 2.7 percent
- Peach State Health Plan (new plans in 2016, so no rate change listed)
- UnitedHealthcare HMO: 13.2 percent (down from the 18.64 percent increase that they originally proposed)
- Alliant: 27 to 29 percent (down from the 37.85 percent they had requested) Alliant’s approved rate filing was not among the data that Georgia provided following my open records request, but the approved rate change was reported by The Telegraph.
Time Insurance exited the health insurance market nationwide at the end of 2015, but Harken Health Insurance has joined the Georgia exchange, so there are still nine carriers offering plans in 2016.
For most people, subsidies will pick up a portion of the rate hikes. But subsidies are tied to the benchmark premiums, which have only increased by an average of 6.1 percent in Georgia for 2016. Since rate changes for some plans are considerably higher, it’s particularly important for enrollees to shop around during open enrollment rather than simply letting their coverage auto-renew. That said, if you did let your plan auto-renew (across all Healthcare.gov states, about 40 percent of people who had coverage in 2015 let it auto-renew for 2016), you can still return to the exchange to pick a different plan for most of 2016, as long as you do so by the end of January.
At the end of 2015 open enrollment, 541,080 Georgians had signed up for qualified health plans (QHPs) through HealthCare.gov, but not all of them paid their initial premiums or opted to keep their coverage long-term. By the end of March, there were 452,815 people with in-force coverage through the Georgia exchange, and enrollment dropped again during the second quarter of the year, with 417,890 effectuated enrollments as of June 30 (Healthcare.gov stepped up enforcement of documentation requirements for immigration and financial status, which caused many people to lose coverage and/or subsidies).
90 percent of them are receiving premium subsidies, and 67 percent are receiving cost-sharing subsidies (available to people with household incomes up to 250 percent of poverty, as long as they select a silver plan). Georgia’s subsidy utilization is higher than the national average; nationwide, 85 percent of exchange enrollees are receiving premium subsidies, and 57 percent are receiving cost-sharing subsidies.
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.
King v. Burwell – subsidies are safe
Fortunately for exchange enrollees in Georgia – as well as hospitals, insurance carriers, and people who purchase coverage without subsidies – the Supreme Court ruled on June 25 that subsidies are legal in states like Georgia that use Healthcare.gov. If subsidies had been struck down, 415,000 people in Georgia would have lost their subsidies and their coverage would likely have become unaffordable.
It would also have become unaffordable for many people who aren’t receiving subsidies, as the entire individual market would likely have seen a rate increase of 55 percent – in addition to the regular annual rate increases – if subsidies had been eliminated. Since coverage would have become unaffordable for so many, healthy enrollees would have been likely to drop their coverage, leaving a sicker pool of insureds and triggering a “death spiral.” It was possible that the individual market could have shrunk in size by 70 percent if subsidies had dried up.
New insurers join exchange in 2015
Georgia consumers shopping for health insurance on the marketplace had nearly double the number of insurers to choose from in 2015 as they did in 2014. In addition, three companies — as opposed to one in 2014 —offered policies statewide. A health insurance expert at Georgia State University said the influx of statewide competition would help reduce disparity in premium costs seen among different regions of the state.
Nine insurers offered plans in the Georgia health insurance marketplace for 2015, including four who were new to the exchange for 2015. The returning companies from 2014 are: Alliant Health Plans, Blue Cross, Humana, Kaiser Permanente, and Peach State Health Plans. The new entrants to the marketplace for 2015 were Cigna, Coventry, UnitedHealthcare, and Time Insurance.
2015 premiums up just 1 percent
Georgians paid an average of 1 percent more for health plans on the marketplace in 2015 compared with 2014. The overall average was weighted and considered all metal tiers. The average cost of bronze policies was down 4 percent, and the average cost of silver and gold policies was down 1 percent. But the average cost of platinum policies was up 33 percent (very few enrollees nationwide select platinum plans due to their cost).
Given that southern Georgia had some of the highest premium costs in the nation for 2014, the modest average increase was 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, HealthCare.gov. 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. By the first half of 2015, the state’s uninsured rate had dropped to 15.3 percent – still well above the national average, but much better than the 21.4 percent uninsured rate that Georgia had in 2013.
Georgia health insurance exchange links