Chattanoogans who don't have health insurance through their employer, Medicare or TennCare have a variety of options to choose from to buy individual insurance plans through the health exchange marketplace.
In most instances, premiums for next year won't be increasing as much as in prior years, and some new plans will offer cheaper options than what is currently available.
As sign-ups for 2024 coverage plans begin this week, most consumers also should be able to qualify for government assistance with their health plans.
The Tennessee Department of Commerce and Insurance has approved six insurers for individual policies offered through the Affordable Care Act health exchange for 2024, including four in the Chattanooga market. On average, insurers were granted rate increases smaller than in a year ago, when rate increases averaged 8.5% for 2023, or two years ago, when regulators approved a 4.4% average rate increase for 2022.
"Base monthly premium rates remain mostly unchanged," said Bobby Huffaker, founder and president of American Exchange, which helps consumers connect with the exchanges created under the Affordable Care Act. "Tax credit eligibility is important since that reduces the cost of the monthly premiums and provides cost sharing reductions (lower deductible, out of pocket maximums and copays) in the Silver Level plans. Many uninsured Tennesseans are eligible for a monthly premium of less than $100 on the exchanges."
In the Chattanooga area, there are 67 different individual and small employer plans through the health exchange marketplace from BlueCross BlueShield of Tennessee, AmBetter (owned by Celtic Insurance), Cigna and United Healthcare.
"We strongly urge Tennesseans to begin their review and planning as early as possible to avoid missing deadlines," Tennessee Insurance Commissioner Carter Lawrence said in a statement after approving the plans and insurance rates. "Once the open enrollment period closes in January, consumers can only enroll in a health plan after certain qualifying life events occur."
Health exchange enrollment grows
With TennCare rolls shrinking due to the end of automatic renewals in the Medicaid program, a record number of Tennesseans are getting their health insurance through the health care exchanges started after the adoption of the Affordable Care Act, or Obamacare program, in 2010. Enrollment in such health care plans has more than doubled in the past decade as the market has matured, rates have stabilized and more low-income consumers who don't qualify for TennCare have taken advantage of government subsidies to help purchase individual or small group plans.
"The Affordable Care Act has been an incredible success and has established itself as an important resource for many Tennesseans who otherwise live with anxiety and financial insecurity," said Michele Johnson, executive director of the Tennessee Justice Center, a nonprofit group that has advocated for the expansion of the Medicaid program under the Affordable Care Act.
Growth in Tennessee enrollment in Obamacare Marketplace Plans
Enrollment in health care exchange plans offered under the Affordable Care Act has more than doubled in Tennessee since the program began 11 years ago.
— 2014: 151,342.
— 2015 : 231,440.
— 2016: 268,867.
— 2017: 234,125.
— 2018: 228,646.
— 2019: 221,553.
— 2020: 200,445.
— 2021: 212,052.
— 2022: 273,680.
— 2023: 348,097.
Despite a jump in premiums by many health insurers in the first few years of the program and calls in the past to repeal Obamacare by many Republicans, Johnson said premium rate increases have slowed and the average increase next year is below the overall inflation rate.
"I think the polarization and controversies we initially saw over Obamacare are behind us and the Affordable Care Act is here to stay, offering people surprisingly affordable options to provide the health care people need in our state," Johnson said in a telephone interview Friday.
Picking a plan
The marketplaces offer plans with a range of premiums, which is the cost of coverage. They are grouped into platinum, gold, silver and bronze levels. The last level generally is cheaper but also requires patients to pay more toward their care.
Shoppers can get income-based tax credits to help buy coverage. The tax credits are based on what you expect to make in the coming year, and the U.S. Department of Health and Human Services estimates 4 out of 5 people enrolling in one of the health exchange programs should be able to find coverage for $10 or less per month after subsidies.
"There's good affordability this year," said Cheryl Fish-Parcham, director of access initiatives at Families USA, a health insurance advocacy group.
More generous help with monthly insurance premiums was first offered as part of the federal government's pandemic relief program, and the Inflation Reduction Act extended it through 2025.
In general, you are eligible for marketplace coverage if you lack affordable coverage through your job or don't qualify for government health insurance programs like Medicare and Medicaid. Many people who haven't shopped on the marketplace don't know that they can get this help, according to Jeremy Smith, who directs West Virginia's health insurance navigator program.
"What we find is until people need to know, they don't know," he told The Associated Press.
In an email statement Friday, Huffaker said he created American Exchange to help provide assistance for individuals and employers navigating their health care options under the marketplace exchange. Since the Chattanooga business was started, it has helped more than 125,000 people find coverage in plans across the nation.
During open enrollment this year, American Exchange is adding 16 more employees to double its staff size to help respond to customer inquiries, Huffaker said.
Those signing up are urged to compare plans to make sure their doctors and other providers are in the networks selected by each managed care plan and any prescription drugs they regularly take are covered by the plan they select. Additionally, consumers should consider both the monthly premiums they pay and the copays and deductibles they may be required to cover for many prescriptions, treatments or hospital care.
Many low-cost marketplace plans come with deductibles that can require patients to pay thousands of dollars before most coverage kicks in.
"A lot of people don't understand how deductibles work," Smith said. "They're just used to having health coverage ... and it covers everything."
Plans also can come with annual out-of-pocket maximums no higher than $9,000 for individuals and $18,000 for families. That's the most a patient will have to pay in a year for covered services before insurance starts covering all the cost. Shoppers should think about whether they could handle big expenses like that.
The marketplace can provide some help with these costs, too. People with incomes below 250% of the federal poverty level can qualify for cost-sharing reductions if they pick a silver plan. That means they get lower deductibles and out-of-pocket maximums.
"The good news is a lot of people who've been in Medicaid will likely qualify for these cost-sharing reductions," said Sabrina Corlette, co-director of Georgetown University's Center on Health Insurance Reforms.
BlueCross adds Erlanger-based plan
BlueCross, the state's biggest health insurer, is expanding its Network E offering to the Chattanooga market next year in a partnership with Erlanger Health System that will feature premiums priced 18% below the company's broader Network S plan and below the current rates for any of BlueCross's individual plans. The new health exchange plan is a more restrictive health network that requires members to use Erlanger doctors and facilities for most care, or pay higher copays and deductibles.
Chattanooga health care plans
Four health insurers will be offering 67 different plan options in the Chattanooga market through the health care exchange program in 2024. Those offering plans in Chattanooga, and their rate changes planned for next year, include:
— BlueCross BlueShield of Tennessee — average requested rate change of 2.7%, ranging from -5.9% to 16.3%.
— Celtic Insurance doing business as Ambetter Health — average requested rate change of 6.7%, ranging from 3.5% to 7.9%.
— Cigna Health — average requested rate change of 2.6%, ranging from -7.9% to 4.2%.
— United Healthcare — average requested rate change of 1.9%, ranging from 0.7% to 7.75%.
Source: Tennessee Department of Commerce and Insurance
"We're excited to provide more affordable options for our neighbors in Chattanooga thanks to our partnership with Erlanger," BlueCross spokesperson John Hawbaker said in a telephone interview. "We will have the lowest cost silver and bronze plans in the Chattanooga region."
BlueCross is also offering no-cost virtual telemedicine care on all its plans to help members stay healthy, Hawbaker said.
The Associated Press contributed to this story.
Find out more
Individuals or small employers with fewer than 50 employees who may be purchasing or changing their health coverage on the federally facilitated marketplace for 2024 may enroll in one of the health exchange plans during the sign-up period that runs from Nov. 1 until Dec. 15. Plans start Jan. 1. More information at healthcare.gov.