A few months ago, it was feared that there would be a major increase in premiums for ObamaCare come 2019. “The individual market, which had shown signs of stabilizing, now faces a potential deterioration of the risk pool due to policy changes that reduce incentives for healthy individuals to enroll in [ObamaCare] marketplace plans. This deterioration and other factors could drive premiums higher for 2019,” explained senior health fellow Cori Uccello back in June.
The good news is that the tides have shifted and premiums in the “health insurance marketplaces are expected either to drop or increase by less than 10 percent in 41 states with about 9 million customers” (Alonso-Zaldivar, The Associated Press). Millions of people covered by the Affordable Care Act will experience modest premium increases by next year, and some will even get price cuts. The Associated Press and its consulting firm, Avelere Health, concluded that ObamaCare’s health insurance marketplaces may have finally stabilized after 2 years of tumultuous price increases.
It’s expected that 11 of the 41 states should expect a drop in average premiums, while 6 other states, including Washington, D.C., might experience a premium hike between 10 to 18%. Insurers are also expected to make a comeback, with more individuals expanding into more areas. Cigna and Oscar are two insurers slated to expand into new counties, while Bright Health and Celtic have penetrated the marketplace.
According to Deep Banerjee of Standard & Poor’s, previous premium increases paved the way for insurers gaining back profitability after losing hundreds of millions of dollars in the past. “Repeal of the ACA’s requirement to carry insurance doesn’t seem to have had a major impact yet,” but Banerjee explains there’s “a cloud of uncertainty around the Trump administration’s potential policy shifts.” A premium stabilization program has also helped settle the markets and may hopefully aid in driving down the premium costs for 2019.
The bigger question is: are prostheses covered by the Affordable Care Act? As a result of ObamaCare, “all individual and small group health insurance plans must now cover something called Essential Health Benefits, or EHBs.” According to healthcare.gov, these are “services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills.” Individual and most small-group plans and employers with 50 or fewer employees are required to cover prosthetics in some way.
On the flip side, large employers are not required to cover prosthetics or other devices and/or services that are related to these EHBs. Most still do, but it’s highly recommended that you revisit these policies with your employer, health care provider, or insurer in order to figure out what you need to pay for (or what they can potentially cover) in 2019.
We encourage you to have these long conversations with your health care provider and triple check and do your homework. You don’t want to be unpleasantly surprised next year with many prosthetic services requiring an out-of-pocket payment, or even worse—you absolutely do not want to be caught off guard in the event of an emergency.