Enhanced premium tax credits under the Affordable Care Act are set to expire, pushing ACA marketplace enrollees toward cheaper, high-deductible bronze plans. According to Margaret A. Murray, M.P.A., the shift could ultimately cost some consumers thousands more than staying in a silver plan, once deductibles and cost sharing are factored in.
Hidden costs in cheaper plans
Murray, founding CEO of the Association for Community Affiliated Plans (ACAP) and a member of the Managed Healthcare Executive editorial advisory board, noted that ACAP anticipated this trend in a paper produced with consulting firm Wakely. The analysis found that enrollees moving to ACA bronze plans for lower premiums could end up paying roughly $8,000 more out of pocket than they would have in a silver plan.
Whether people will continue paying premiums once they understand what is not covered is an open question.
Most ACAP-affiliated plans are seeing overall marketplace enrollment declines, Murray said, with a few exceptions tied to state-specific trends, such as plans that picked up members after Aetna exited the ACA marketplaces. Because Medicaid and marketplace eligibility are both income-based but at different levels of income, she added, people losing Medicaid coverage are not generally shifting over to the ACA marketplace plans, or vice versa.
Related: Margaret Murray Critiques Republicans on Medicaid Stance
One must wonder how many consumers will catch the math before they sign on the dotted line. The financial risk is significant, yet the allure of a lower monthly bill is often immediate and persuasive. If the underlying coverage structure is fundamentally different, a lower premium might not translate to lower overall expenses for the average household.
The threat of nonnetwork plans
Murray said ACAP is also concerned about the Trump administration unwinding Biden-era restrictions on short-term, limited-duration “junk insurance” and a proposal to let consumers use ACA premium tax credits toward nonnetwork plans. She described nonnetwork plans as functioning like a coupon a patient can take to any provider, with the plan paying a set amount.
“With a nonnetwork plan, you get a coupon, essentially, to go to a provider and say, ‘I have coverage with this coupon for so many dollars.’ But then the provider ends up charging you more — and there’s no reason they wouldn’t — [and] you are on the hook for the additional amount. It’s really underinsurance,” says Murray. “We have come out very strongly against nonnetwork plans and, in fact, led the charge and drafted a letter to the administration with some of the other insurance associations and the hospitals, saying why these were so problematic.”
