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Good Deals For Some, Sticker Shock For Others As ACA Enrollment Winds Down

For many, Friday night is the last chance to sign up for Affordable Care Act health insurance for 2018. How did it go for individual consumers shopping for plans this year? Much depended on where you live and what your financial situation is. (Photo by Karen Bleier/AFP/Getty Images)

In most states, Friday night is the last chance to sign up for Affordable Care Act health insurance for 2018. The enrollment period is half as long as last year’s, and it got just a fraction of the marketing budget to tell consumers that.

But how did it go for individual consumers shopping for plans this year? Much depended on where you live and what your financial situation is.

In Tennessee, where state regulators approved average rate increases ranging from 20 percent to 40 percent, consumers might have reasonably expected to brace for a big hit to their wallets. But Brenda Linn saw the opposite happen.

Linn had been paying $750 a month in 2017 just to cover her own medical needs; so the retired kindergarten teacher and her husband logged on to to check the price of 2018 plans. To her surprise, the website brought up a great deal.

She thought it was a mistake. The price Linn was quoted was less than $5 a month. Why? A slight loss of income had made her eligible for a subsidy for 2018. “Because we didn’t qualify last year, I wasn’t really that hopeful,” Linn said.

But a large majority of marketplace shoppers do get subsidies. And for 2018, on aggregate, these subsidies are larger.

Tony Garr, a volunteer application assistant with the Tennessee Health Care Campaign, said more than ever this year, people needed to shop around on the exchange.

“Generally speaking, they will find out that help is there,” he said.

Any many people who got a subsidy in the past found even more for their money this year.

For example, Daniel Prestwood, who is self-employed and cleans fish tanks around Nashville, said he found a better plan for 2018, with monthly premiums that dropped from $300 to $200. He said he tries not to get too frustrated by the political wrangling over health care.

“All I know is that for 2018 I’ll have a good health care plan in place,” he said, “and that’s the best I can hope for at this point.”

And even with the Trump administration’s efforts to hobble the ACA, in Tennessee, the number of applications processed by federally funded insurance guides — known as navigators and certified application counselors — surpassed last year’s. With 10 days left in open enrollment, more than 1,200 individuals had applied with official help, eclipsing the total from all of 2016, when the enrollment period was several weeks longer.

While application assistants only work with a tiny fraction of the 235,000 Tennesseans who have marketplace plans, Sandy Dimick of Family and Children’s Services Nashville, said she expects total enrollment will exceed last year’s total, as well.

But many people across the country had a very different experience than Linn and Priestwood.

Gene Kern of Frederick, Md., has been an enthusiastic enrollee in Maryland’s health exchange since it began in 2014. The 63-year-old retired early from Fujifilm, where he sold professional videotape. “When the product became obsolete, so did I,” he said, “and that’s why I retired.”

This fall, Kern said, he received a letter from his insurer explaining that the cost of his policy’s premium would jump from $800 a month to $1,300 in 2018.

“Because of my income, I am slightly above the 400 percent poverty level,” he said, “and as a result I get no subsidy from the government.”

So Kern shopped around on Maryland’s exchange — which announced on Wednesday that it will be open an extra week, through Dec. 22 — and he found an HMO plan for around $900 a month. That’s more than 20 percent of his income, which comes partly from Social Security and partly from his retirement account. But, he said, “It’s the best I can get.” Kern wants to stay insured for the next two years, until he will qualify for Medicare.

Louise Norris, a health insurance broker and analyst in Colorado, said there are a number of people like Kern who earn too much for a subsidy and will pay more for health insurance next year than they did in 2017. “Rates are high,” she said. “There’s no way to sugarcoat that.”

But she warns her clients against the temptation to shop off the exchanges for a less expensive plan that doesn’t comply with the minimum standards set out by the ACA.

“It seems like a good deal because it’s cheap,” Norris said. “But then you find yourself being that person who has a heart attack and needs triple bypass. And hundreds of thousands of dollars later you wish you had that ACA-compliant plan.”

While people in states that use have until Dec. 15 to sign up, residents of nine states (California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, New York, Rhode Island and Washington) and the District of Columbia have slightly more time.

This story is part of NPR’s reporting partnership with local member stations and Kaiser Health NewsSelena Simmons-Duffin, a producer at NPR’s All Things Considered, is working temporarily with NPR member station WAMU, as part of an exchange program at the network. Blake Farmer is the health reporter at Nashville Public Radio.

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