CHARLESTON — The open enrollment period for health insurance through the Affordable Care Act kicked off this week with an extended time frame that will give uninsured West Virginians or those looking to adjust their plans until Jan. 15 to choose one that works for them.
This will be the ninth open enrollment period through the Marketplace, and this year some different options will be available to more West Virginians due to changes made in response to the COVID-19 pandemic.
“The biggest thing different this year is that the plans are going to be more affordable. Because of changes through the (American Rescue Plan Act), people that get their Marketplace health insurance, they’re going to qualify for increased subsidies this year,” said Jeremy Smith, head of the West Virginia Navigator, a state nonprofit helping people enroll in and retain health care coverage.
For coverage to start Jan. 1, people should try to enroll in a plan by Dec. 15.
Open enrollment allows people who do not receive health care from their employer or who do not qualify for programs like Medicaid to purchase individual insurance policies. In West Virginia, insurance companies CareSource and Highmark Blue Cross Blue Shield will have ADA-compliant, individual plans available for consumers on the Marketplace.
All plans purchased during the open enrollment period will provide coverage through 2022.
Smith said people searching the Marketplace for the first time, or those who previously opted to go without such coverage, may be surprised to see what they qualify for.
“Now, even a lot of the higher income people in this state are potentially going to qualify for lower deductibles through subsidies and tax credits that, before, weren’t available,” Smith said. “It’s going to mean more options and, I hope, more people coming back (to the Marketplace).”
Plans and premiums change on the Marketplace annually, and those already enrolled should ensure their plan still offers what they need. This includes checking to see if physicians or specialists are still in their network, the deductible and co-pay balance, how many visits are covered for certain kinds of services and other case-by-case specifics.
Through the American Rescue Plan, eligibility for premium tax credits was extended to reach people with an income over 400% of the federal poverty level (about $51,500 a year for an individual and $87,800 for a family of three).
People who make up to 150% of the federal poverty level could qualify for expanded premium subsidies this year, which could reduce deductibles and co-pays for consumers.
“Having more affordable plans, more flexible options — it’s going to make a huge difference I think, especially in West Virginia,” Smith said. “We know that if someone doesn’t have health coverage, they put off small illnesses that can eventually become a big issue. It makes quality of life worse; premature death is more common. I really hope, with these options, we’ll see more people become insured, protected.”
Smith has worked as a “navigator” helping people enroll in health insurance since the ACA Marketplace first went public in 2013. Over the years, he’s witnessed different trends in enrollment as the program has shifted.
In the beginning, he said, people seemed happy and content with the options available to them through the Marketplace and the costs associated.
“Then for a variety of reasons over the years, the pricing went up and the options changed and networks changed. People got frustrated, and many walked away,” Smith said. “A lot of people just went without health insurance.”
According to the Kaiser Family Foundation, 5% of West Virginians — 88,400 individuals — were uninsured in 2020. That’s down from 2018, when 106,000 residents reported lacking health care coverage.
Nearly half of the residents who were insured in 2020 received their coverage from an employer, per the Kaiser Family Foundation. About 22% of the state was covered by insurance through Medicaid, and another 20% by Medicare.
Per the federal Centers for Medicare and Medicaid Services, about 18,000 West Virginians — roughly 1% of state residents — are provided health care through the Marketplace.
Alan McVey, state insurance commissioner, said Nov. 1 he wanted to ensure those who are uninsured or who do rely on the Marketplace for coverage are listening.
“That’s who I would like to speak to today, the uninsured, because if you do not have health insurance, you’re one serious injury or one serious illness away from, as mentioned, having to spend all of your life’s savings or even having to file bankruptcy,” McVey said.
Smith said he believes the truth of that statement hit many people during the pandemic, as unexpected illness and potential hospitalization became a real danger for many.
He said as the pandemic went on, more people were reaching out to West Virginia Navigator for assistance getting enrolled in a coverage plan.
“We had people coming to us and saying, ‘We need this. We can see how dangerous this is, and we want to make sure we’re covered,’” Smith said. “I think (the pandemic) did open people’s eyes, especially if they or someone they knew got sick. We did see an increase in people coming to us because of that.”
This year the Navigator will see an increase in funding through a federal grant. Through the past several years, Smith said, the agency has had its budget cut to roughly $100,000 annually to serve the whole state.
Now, that’s increasing tenfold.
“We’re getting $1 million a year now, and we’ve been able to hire 10 additional navigators, open three other offices in the state and generally grow how much help we can offer people,” Smith said.
There’s more funding available for travel now, allowing the group to set up mobile enrollment events across the state and encourage more health coverage in every region. The phone helpline is more accessible now and includes a Spanish speaking option.
Smith urged people to stay off Google and other search engines when researching health insurance plans because they’re complicated, and some companies and plans can be predatory. Instead, he said, contact the West Virginia Navigator and talk through the process with an expert.
“We’re excited, really because we want to bring enrollment, (health insurance) coverage, to more people. We know when we have more people protected, the better off a community — all communities — are,” Smith said. “That’s what we’re working on today, and I am very hopeful for this year.”
West Virginia Navigator services are free for state residents and can be accessed by visiting https://acanavigator.com/wv/home or calling 844-WV-CARES.