Whether or not Missourians feel sticker shock when shopping for insurance coverage on HealthCare.gov this fall will depend on their income and where they live.
On average, premiums are increasing in almost every county in Missouri for 2017 coverage, and they’re climbing nationwide too.
Yet, the rate of those average premium increases varies widely by location, according to data compiled by the Associated Press. And many consumers will be shielded from steep increases because of federal financial assistance that’s provided to them based on their income.
So while premiums are increasing, so too are the financial subsidies that help eligible consumers across the country buy health insurance coverage.
For example, a 40-year-old nonsmoker living in St. Louis County earning $30,000 annually will pay about $202 per month in premiums for the lowest-cost silver plan. Last year, that same 40-year-old paid $190 per month for the same plan.
In this example, the 40-year-old benefits from a $103 monthly premium discount, based on income, shielding him or her from a larger increase, according to data compiled by the Post-Dispatch.
About 87 percent of Missourians who purchased plans through HealthCare.gov last year received some sort of financial assistance because of their income, according to data from the U.S. Department of Health and Human Services.
And that’s the angle federal health officials keep pushing as critics say the price increases mean the Affordable Care Act is faltering.
“Thanks to financial assistance, the large majority of current Marketplace consumers in Missouri will be able to find plans with premiums between $50 and $100 per month,” HHS Secretary Sylvia M. Burwell said in a statement.
However, those who don’t qualify for financial assistance may experience sticker shock when they start shopping for coverage during open enrollment, which starts Nov. 1.
Missouri’s rural counties will be particularly hard hit by higher premiums. The Post-Dispatch’s analysis found that average increases were higher in the Missouri counties that have only one carrier. However, many of the counties that saw premiums jump the most already had higher premiums to begin with.
In Boone County, average premium prices are expected to increase 34 percent for those not receiving financial assistance, according to AP’s data that use the second-lowest cost silver plan purchased by a nonsmoking 50-year-old as the benchmark to compare plans nationwide.
“This is a public concern,” said Sidney Watson, health law professor at St. Louis University School of Law. “The overall cost of marketplace plans is something we all ought to worry about.”
One reason St. Louis County is not seeing large rate increases is because there are still two carriers competing for business, Watson said.
Network concerns
In 2016, St. Louis County had four carriers competing for business. In 2017, that number will drop to two after Aetna and UnitedHealth decided to stop selling plans on HealthCare.gov in Missouri for 2017 coverage.
With Aetna and UnitedHealth’s departures, 96 of Missouri’s 114 counties will have only one insurance carrier to choose from when shopping on HealthCare.gov for 2017 coverage.
Aside from price, the carriers’ departures have implications on the networks and doctors people will have access to.
One of the biggest concerns is that there are few overlaps in the networks of the remaining two insurance carriers in St. Louis County.
It will be a decision of sticking with your doctors and paying a higher price, or switching doctors for a lower-priced plan, said Emily Bremer, a health insurance broker in Clayton.
In general, Cigna covers BJC and its doctors and facilities.
And Anthem, the only other carrier, covers SSM Health doctors and facilities but not BJC.
Bremer said area consumers needed to take a “hard look” at what they would do for 2017 because the differences in plans are drastic.
Samantha Liss • 314-340-8017
@samanthann on Twitter
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