ACA open enrollment 2019: What’s new in TN

Open enrollment for insurance plans on the Affordable Care Act Marketplace runs Nov. 1 through Dec. 15.

Tennessee, especially, will see some changes among those who purchase ACA plans. What to look for in 2019:

More choices

In 2017, for a time, it was unclear if any insurers would offer ACA plans in Tennessee. In 2018, every county in the state was covered — but many by only one insurer.

In 2019, two new companies have entered the game: Bright in three metropolitan markets and Celtic in two. In addition, Oscar and Cigna are expanding their coverage areas, and Blue Cross Blue Shield of Tennessee will offer insurance everywhere but Nashville and Memphis. That means most

counties will have at least two options, and some will have even more.

In Knoxville, Blue Cross Blue Shield, Bright and Cigna will offer plans; in Nashville, Bright, Cigna and Oscar; in Chattanooga, Blue Cross and Celtic; in the Tri-Cities, Blue Cross and Cigna; and in Memphis, Bright, Celtic, Cigna and Oscar.

Lower premiums, for some

In August, when the state’s insurance department approved 2019 rate changes, Blue Cross Blue Shield and Cigna had decreases in their premiums — an average of 14.9 percent and 12.8 percent, respectively. The two are the largest insurers for those enrolled in individual market plans.

Meanwhile, Oscar increased premiums by 7.2 percent to 10.84 percent, on average, and there are two new players with Bright and Celtic.

To complicate matters, rate changes also can affect the amount of subsidies, for individuals eligible for that financial help. Thus, it’s even more important than usual to shop around for plans this year, rather than letting your insurer simply “auto-renew” your current plan.

No more penalty for being uninsured

This is the year the tax bill signed in 2017 to eliminate the individual mandate — the requirement that all Americans, with few exceptions, carry health insurance — takes effect.

In 2018, nearly 229,000 Tennesseans enrolled in ACA marketplace insurance plans, a slight decrease from 2017, though it varied widely across the state.

Thirty counties, for example, saw an increase in enrollees, while seven — including much of Northwest Tennessee — saw an enrollment decline of more than 10 percent. Even after it’s no longer federal law, some states will keep insurance mandates, but Tennessee won’t.

Whether removing the threat of a tax penalty for the uninsured will affect statewide enrollment remains to be seen. But advocate and family physician Dr. Mary Headrick, a former congressional candidate, doesn’t think it will have a broad impact, beyond a subset of younger, healthier people forgoing policies. Headrick points to Medicare, in which Part B supplemental policies are optional, with no penalty for not buying one,

More potential for misunderstandings and ‘scams’

When it was enacted, the ACA established rules insurance plans must meet in order to be compliant — covering a list of “minimum essential benefits,” not excluding patients based on medical history, not charging older or sicker people higher premiums, and covering at least 60 percent of average medical costs and spending most of the amount of premiums on claims, not other expenses.

This year plans that don’t meet those requirements — such as those purchased by organizations through an association — are available, and the length of “short-term” plans intended to fill in gaps between full insurance has been extended from three months maximum to one day short of a year. These plans are likely to be less expensive, but Headrick and others worry people won’t realize until after they’ve enrolled what’s excluded from coverage, such as pre-existing conditions.

In addition, Tennessee this year will allow ACA Marketplace enrollment via phone, making it “open season” for scammers to call uninitiated customers and lead them to believe they’re talking to legitimate Marketplace navigators when they’re not, Headrick said.

How to enroll

Enrollment in Tennessee’s federally run Marketplace can be done through www.healthcare.gov or by calling 1800-318-2596.

But trained volunteers can help people enroll at a number of planned events through December, starting with a kickoff noon-6 p.m. Nov. 1 at Mount Calvary Baptist Church, 1807 Dandridge Ave.

Headrick said those who bring the necessary paperwork can get through the complex enrollment process in less than an hour. Scheduled events are: ❚ 2018 Western Ave.: 10 a.m.-2 p.m. Nov. 3, 17 and Dec. 8; 10 a.m.-6 p.m. Dec. 15.

❚ 1807 Dandridge Ave.: 10 a.m.-2 p.m. Nov. 10 and Dec. 1.

❚ 1220 W. Main St., Sevierville: 1-3 p.m. Nov. 7, 14 and 28 and Dec. 5 and 12.

❚ 522 Maryville Pike: 3-7 p.m. Nov. 15 and 29 and Dec. 13.

❚ 508 North Cusick St., Maryville: 3-7 p.m. Nov. 13 and 26 and Dec. 10.

Cherokee Health System, Mount Calvary Baptist Church, Sevierville Senior Center, South Knox Community Center, Blount County Library,