By SHANNON HAUGLAND
Sentinel Staff Writer
Continued higher federal subsidies, an additional insurance company in the market, and new plan options should combine to help Alaskans find a health insurance plan that works for them, a Sitka health insurance expert says.
“You cannot predict what’s going to happen and, yes, health insurance costs money and it’s a pain, but you really should have it,” said Susan Briles, SEARHC patient health benefits manager.
Sign-ups for the federally subsidized Affordable Care Act health insurance marketplace opened Nov. 1 for coverage starting Jan. 1, 2023. Those wanting coverage starting then – or to continue their current coverage – must sign up by December 15. The deadline after that is January 15 but coverage won’t start until later.
While individuals can sign up or make changes by themselves through their healthcare.gov account, four SEARHC specialists are available in Sitka to help anyone wanting free advice on their current plan, adjustments for income changes, new plans being offered, or increasing, lowering or otherwise changing coverage.
Briles updated the Sentinel recently on some of the changes for the 2023 healthcare marketplace. She said that since Nov. 1, 30 people have enrolled so far in the region with the help of her office and more than 50 have appointments. She and other specialists can be reached for an appointment, or to answer questions, at (907) 966-8684.
Briles said there are several reasons everyone should look at their healthcare coverage every year.
“You don’t necessarily have to redo it every year, but I highly recommend it because you want to make sure none of your information has changed,” she said. “You want to update your income, and it’s important to do so, so you don’t end up owing money back in taxes.”
Monthly premiums for marketplace insurance are based on age, the type of plan, and household income and size. Generally, residents are eligible to purchase plans through the marketplace if they aren’t offered health insurance through their workplace, or are ineligible for Medicaid or Medicare.
In Alaska, Premera Blue Cross is considered the plan of choice for most people, but after a 9-year absence Moda Health is back, with a broad range of offerings and prices for 2023.
“Premera has added a new type of plan – a little less expensive than the other Premera plans,” Briles said. “The standard plans are still out there – gold, silver, bronze – but they’ve added other options.”
For instance, she said, “Premera has a bronze plan but with a high deductible – $9,100 – and it won’t pay for anything until you meet the deductible.”
As to the difference between bronze and gold plans, healthcare.gov says:
“Bronze plans usually have the lowest monthly premiums but the highest costs when you get care. They can be a good choice if you usually use few medical services and mostly want protection from very high costs if you get seriously sick or injured. Note: Bronze plan deductibles can be very high.”
Briles said she can’t imagine it would be a popular choice for most people, but it can offer protection if you are hit with unexpected healthcare costs higher than the deductible amount.
A gold plan covers 80 percent of covered healthcare costs. “The percentage you’re responsible for consists of the deductible, co-payment and coinsurance payments,” healthcare.gov says. A silver plan is the next rung down, covering 73, 87 or 94 percent of healthcare costs.
The federal government subsidies implemented during the pandemic under the American Rescue Plan Act are still in place.
Briles outlined to the Sentinel a few examples of coverage options and subsidies.
A single 35-year-old single man making $70,000 will get $231 a month in subsidy. This person would pay $284 a month for a bronze plan, and $454 a month for a top-of-the-line Gold plan. Briles noted the income and the fact the person is single puts him at 400 percent of the federal poverty level.
The same person making $40,000 a year – 250 percent of the FPL – would receive a $613 a month subsidy. For a bronze plan they pay $4.38 a month, and can opt for Gold, the best coverage available, for $72 a month.
A family of four, with parents ages 40 and 42, making a total of $140,000, with two children at home, would pay $277 a month for the Bronze plan, and $850 a month for the Gold plan after receiving the subsidy.
Briles said the deductibles for any of the 2023 plans don’t appear to have changed.
The Affordable Care Act (Obamacare) was signed into law in 2010, and sign-ups began in Alaska in 2013. The law expanded Medicaid to higher income levels (adults earning up to 138 percent the federal poverty level) and provides insurance premium subsidies in the form of tax credits. An important reform under the act forbids insurers to deny coverage to individuals with pre-existing health conditions.
As of August, a total of 12 states still hadn’t expanded Medicaid eligibility under ACA: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming.
During the pandemic Congress authorized higher subsidies under the American Rescue Plan Act starting in March 2021, and the subsidies remain in effect, Briles said.
