Stephanie Innes, Arizona Republic
Maricopa and Pima county residents will have more choices of Affordable Care Act health-insurance plans for 2019, though fewer federal dollars will be available to help people enroll in them.
Open enrollment for 2019 plans starts Nov. 1 and ends Dec 15. Preliminary reports indicate Arizonans on average will see marketplace premiums either stay the same or reduced in 2019.
In spite of persistent talk in Washington about undoing the Affordable Care Act, the health-insurance marketplaces, which were created by the ACA, remain intact.
Federal subsidies are expected to be available to those who qualify.
In 2018, most Arizonans who purchased an ACA plan qualified for a subsidy, federal data show. In 2018, each of Arizona’s counties had just one insurance company selling ACA plans. Such plans are often also referred to as “Obamacare” insurance and provide coverage to about 155,000 Arizonans.
Residents of Maricopa and Pima counties will no longer have to rely on just one company for ACA marketplace plans in 2019.
Four companies confirmed with The Arizona Republic that they have filed paperwork to sell ACA marketplace plans to Maricopa County residents for the 2019 coverage year: Minnesota-based Bright Health; New York-based Oscar Health; Pennsylvania-based Cigna Health Insurance; and Tempe-based Ambetter from Arizona Complete Health (owned by Missouri-based Centene Corp.).
In 2018, only Ambetter, formerly called Ambetter from Health Net, offered ACA plans to Maricopa County residents. Ambetter also was the only choice for Pima County residents in 2018.
“Despite the rhetoric and heated debate, we’re actually seeing stabilization in the individual ACA market. We are seeing that in Arizona,” said Kyle Estep, who is Oscar Health’s central region market director.
At least three companies are expected to offer ACA marketplace plans in Pima County in 2019, up from just one company in 2018 — Blue Cross Blue Shield of Arizona, Bright Health and Ambetter from Arizona Complete Health.
“We are telling consumers there will be more choices at lower costs. Most marketplace consumers will find a plan for less than $100 per month for an individual,” said Marcus Johnson, director of state health policy and advocacy for the non-profit Phoenix-based Vitalyst Health Foundation.
The health-insurance marketplaces, sometimes called exchanges, were created by the ACA to offer insurance plans to working-age individuals and families who are not covered by other insurance such as Medicaid or employer-sponsored coverage.
While some states operate their own exchanges, Arizona uses the federally facilitated marketplace, which operates via the website healthcare.gov.
“We’re encouraged more plans will be available on the Arizona marketplace, but it’s unfortunate there will be fewer resources to help people navigate them,” Johnson said.
Federal ‘navigator’ grants to states that are meant to help educate and enroll people in health insurance were slashed by more than half this year. Arizona’s allotment of money went down by 74 percent — from $1.17 million last year to this year’s $300,000.
Health Net customers who now get care at Dignity Health’s St. Joseph’s, Chandler Regional or Mercy Gilbert hospitals will need to switch providers amid an insurance-contract dispute. Dignity estimates it affects 5,000 patients.
“There will still be help across the state in spite of these cuts,” said Allen Gjersvig, director of navigator and enrollment services at the Arizona Alliance for Community Health Centers, which is administering the grant money. “We will do our best. That’s all we can do.”
The alliance last year partnered with 14 entities to help Arizonans enroll in health insurance. This year the number of partnerships is down to four.
Gjersvig emphasizes that no one needs to pay any money to get help enrolling in health-insurance plans. And enrollment assisters can help individuals and families figure out whether they qualify for marketplace plans or for Medicaid, a government health-insurance program that in Arizona is called the Arizona Health Care Cost Containment System (AHCCCS).
For free, local help in enrolling in the marketplace, Gjersvig encourages Arizona consumers to call 1-800-377-3536 or go to www.coveraz.org.
One change from 2018: There will be no individual mandate that all Americans must have health insurance in 2019, so people who go without insurance, or who purchase non-ACA-compliant insurance, will no longer face federal penalties.
Gjersvig said one of his biggest concerns is that people understand the type of plan that they are buying, and that it covers what they need. With more choices, there’s a higher potential for confusion, he said.
Buying a health plan based solely on monthly costs may end up costing consumers more money in the long run due to high deductibles and coverage limits, Gjersvig stressed.
“The savvy consumer needs to look at the policy to see what is excluded,” he said.
There are consumer protections built into ACA qualified health plans, and they are important protections, said health policy expert Dr. Daniel Derksen, who is associate vice president for health equity at the University of Arizona.
Derksen said it’s important that consumers read the fine print of any plan they buy, particularly if it’s not an ACA qualified health plan. Short-term plans, for example, are allowed to reject consumers for having a pre-existing condition.
And short-term plans may have a long list of exclusions to coverage, including pregnancy and prescription drugs.
On the positive side, more consumers appear to be more knowledgeable about health insurance, about marketplace plans and in general require less assistance than during the first ACA enrollment season, Derksen said. The addition of more plans in Maricopa and Pima counties is another plus, he said.
“It’s welcome news for consumers. With competition there should be better deals for consumers, including those who don’t qualify for (federal) subsidies,” Derksen said.
Moving forward, those insurance companies will need to make sure they garner enough enrollment to at least recoup their costs, Derksen said. In 2014, which was the first year of Arizona marketplace coverage, multiple insurers entered the local market and consumers were overwhelmed with choices. Many insurers priced their plans too low, which is why so many of them pulled out the following year, Derksen said.
But now the pendulum is swinging the other way, with more insurers coming back.
Oscar Health announced in June that it would be expanding into Arizona and confirmed with The Republic that it would be offering ACA marketplace insurance for 2019 in Maricopa County. The company is based in New York and has a growing office in Tempe with more than 400 employees. The company’s marketplace offering in Maricopa will mark its first insurance product in Arizona.
“Our DNA is really health insurance and technology coming together,” Estep said. “When you wake up at 2 in the morning and your kid has a fever and you are trying to decide whether to take them to the ER or not, we offer what we call doctor on call. You call the doctor and they may write a prescription and you avoid an ER visit.”
Oscar encourages its covered members to download an Oscar app and says the aim is to make health care accessible at all times, including virtual medical visits that are available 24/7 and free in most plans. And it encourages members to meet their health goals by offering Amazon credit.
The company attracted media attention in 2016 for an ad campaign in the New York City subway system that highlighted problems with the American health-care system.
Bright Health partners with one health system or network per market to develop insurance plans. In Maricopa County that partnership will be with the Arizona Care Network, providing members access to Abrazo Community Health Network, Dignity Health, Maricopa Medical Center, and Phoenix Children’s Care Network.
“Phoenix Children’s is thrilled to partner with Bright Health and we’re so excited there is another ACA marketplace offering in our region,” said Renee Clarke, executive director of managed care at Phoenix Children’s. “The Bright Health contract allows our health system to again offer in-network care to families purchasing insurance products from the health insurance exchange.”
Phoenix Children’s was not in-network for this year’s Maricopa County Ambetter plans, Clarke said.
“We are excited patients can now receive in-network covered care at Phoenix Children’s facilities and from Phoenix Children’s medical providers through Bright Health,” she said.
In Pima County, Bright Health is collaborating with the Carondelet Health Network.
Bright Health’s partnership model is not about narrow networks, but rather making health care simpler and more personal, said Katrina Cope, who is Bright Health’s Arizona market lead. Bright Health plans to do a lot of community outreach about 2019 plans, and that outreach will include educating the consumers about health insurance, she said.
Bright Health officials say their model eliminates the friction that often exists between providers and insurers.
Two major health insurance companies, Blue Cross Blue Shield of Arizona and Health Net, will drop Affordable Care Act plans next year in Maricopa and Pinal counties, forcing tens of thousands of consumers to switch plans next year.
“Our company is very committed to this model and to providing another option for Arizonans,” Cope said.
Blue Cross Blue Shield of Arizona will be offering plans in all Arizona counties in 2019 except Maricopa, confirmed Jeff Stelnik, the company’s general manager, individual segment.
Stelnik of Blue Cross Blue Shield of Arizona said his company will be stepping up its outreach to Arizonans. He emphasized that Arizona still has about 725,000 people who are uninsured, and that’s a lot of people to reach with messages about preventive health and the benefits of insurance coverage.
“You’ll see a lot more communication from us out there,” he said.
It’s unclear how the lack of an individual mandate will play out, the Vitalyst Foundation’s Johnson said. Some are worried that without the mandate, only sick people will buy insurance and negatively impact the risk pool. But others say the penalties were not much of a deterrent and that taking away the individual mandate won’t significantly change the number of people purchasing marketplace health insurance, Johnson said.
The lack of an individual mandate is one of several uncertainties with the ACA moving forward, Derksen said.
Those uncertainties include the yet-to-be-decided makeup of the U.S. Supreme Court, which green-lighted most provisions of the ACA in a 5-4 decision in 2012, and in a 6-3 decision in 2015 affirmed the ACA’s provision of offering federal health-insurance subsidies to middle- and low-income Americans.
The Nov. 6 midterm elections could also affect health care’s future in the U.S, Derksen said. Last year, the Republican-led Congress made several attempts to repeal the ACA. Among those efforts was legislation that would have cut billions of dollars from the country’s Medicaid program, a government health-insurance program for low-income people that currently covers 1.86 million Arizonans.