WI Gears Up for Exchange Open Enrollment Amid Shifting Market Dynamics

Trump administration to end cost-sharing subsidies; WI premiums to increase an average 36%

October 13, 2017

The Fifth Annual Exchange Enrollment Conference held October 10 in Wisconsin Dells highlighted the many challenges that will face consumers and enrollment assisters across Wisconsin, as open enrollment for the 2018 benefit year is set to begin November 1. The conference was followed by a press release from the Wisconsin Office of the Commissioner of Insurance (OCI) October 12, reinforcing the ongoing market dynamics. The OCI announced premiums will go up on average of 36 percent in ACA-compliant plans in 2018. 

The impact on consumers overall is difficult to predict. Insurers, facing concerns that the cost sharing reductions (CSRs) they are required to offer to low-income individuals won’t be reimbursed by the federal government, offset this risk by increasing premiums in the silver level plan. Indeed these concerns were realized late Thursday evening (October 12) as the Trump administration announced it will no longer make CSR payments to insurers. A report in August by the Congressional Budget Office (CBO) analyzed the impacts of not funding the CSRs. Details about these impacts were reported by WHA and are described here.

Premium tax credits are tied to the amount of premium for the second lowest cost silver plan in the exchange market. As the premium for the second lowest cost silver plan increases, so too does the tax credit, while the amount the consumer has to pay generally stays the same. Thus, because insurers increased premiums significantly for the silver level plans to account for their losses for the CSRs, the tax credits for consumers will go up, offsetting the premium increase. With a larger tax credit, consumers might want to shop around for different plan options. On the other hand, consumers without tax credits will likely face higher premiums. 

For consumers, and those assisters helping them to enroll in coverage, the premium change is just one of the many dynamics in play. Speakers at the Enrollment Conference noted several additional challenges for the upcoming year. First, the open enrollment period will be shorter, running from November 1 through December 15. Second, the federal government has already announced the healthcare.gov system will be taken offline for maintenance at various times throughout the enrollment period. Finally, funding for enrollment assisters was cut over 40 percent this year. 

Joanne Alig, WHA senior vice president, policy and research, participated in a panel discussion along with Casey Himebauch, Wisconsin’s deputy Medicaid director, and Andrea Callow with Families USA.  The panel discussed what consumers will need to know for 2018. 

Alig highlighted that consumers will need to consider if their current insurer will still be participating in the exchange in their county in 2018. “By our count, there will be at least 50 counties that will have fewer insurers participating in that county,” said Alig. “Consumers will need to review plan options, consider the provider networks and make choices about the plan that is best for them.”

Along with their announcement October 12, OCI released their latest map of insurers participating in the individual market and the exchange market by county. The latest information is similar to the information released by WHA in August (See VV article) with a few notable changes for Security Health Plan. Security is expanding their coverage area to include Buffalo, Florence and Menominee counties, but will no longer participate in Monroe and Waushara counties. An updated county-by-county table from WHA can be found here.

The OCI’s press release is here. A link to OCI’s table showing the premium amount for the second lowest cost silver plan by county can be found here

This story originally appeared in the October 13, 2017 edition of WHA Newsletter