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This image provided by U.S. Centers for Medicare & Medicaid Service shows the website for HealthCare.gov. (U.S. Centers for Medicare & Medicaid Service via AP)

Chattanooga consumers who began signing up Monday for Affordable Care Act health plans for next year have a record number of options to choose from with more modest premium increases than in most previous years.

Bright Healthcare, a health insurance provider that entered Tennessee's health exchange market in 2019, is expanding into Chattanooga this year, competing with other health plans offered by BlueCross BlueShield of Tennessee, United Healthcare, Ambetter and Cigna in offering plans for 2022 in the Chattanooga market.

"We not only have more providers, but plan selections in Chattanooga increased as well, with an additional 29 more plans being offered in our county, bringing the total to 69 plans, up from 40 in 2021," said Rachel Cullor, co-director of customer service at the Chattanooga-based American Exchange, an insurance broker that helps consumers pick health exchange plans across the country.

On average, premiums for the health plans offered through the exchange markets under the Affordable Care Act, also known as Obamacare, will be up 4.4% in Tennessee, although some carriers are lowering their rates for next year.

"That is still below the typical medical rate of inflation which shows you the benefit of a competitive market," said Bobby Huffaker, co-founder and CEO of American Exchange.

Obamacare rate changes for 2022

For the roughly 240,000 Tennesseans who are enrolled in one of the health care exchanges offered through the Affordable Care Act often called Obamacare, a half dozen health insurers plan to offer individual coverage plans in Tennessee next year. Only BlueCross BlueShield of Tennessee is offering plans in all 95 counties, while the other five will offer plans to selected areas of the state. The average change in premiums next year for the new plans will be 4.4%, but they differ among the six insurers.

— BlueCross BlueShield of Tennessee, up 8.2%

— Cigna Healthcare, up 6.2%

— Celtic/Ambetter, no change

— United Healthcare, down 2.4%

— Bright Health, down 3.3%

— Oscar Health, down 3.7%

Source: Tennessee Department of Commerce and Insurance

The rate increases for next year also are far below the initial jump in premium charges made after the initial implementation of the Affordable Care Act seven years ago and in most instances are being offset by subsidies and tax credits, especially for low- and moderate-income customers.

"While there are slightly higher rates for many plans next year, it still is highly affordable for most people, especially considering that 89% of those enrolled receive some level of subsidy," said Michele Johnson, co-founder and executive director of the Tennessee Justice Center, a Nashville-based advocacy group that supports the Affordable Care Act.

"It's really important to get people enrolled, and we're happy that the federal government is promoting enrollment again this year," she said. "We know if you have health insurance, you are much less likely to die of preventable causes and more likely to live with less medical debt. Even though rates may be higher, the subsidies may still make a plan very affordable for most people."

Although subsidies decline as income rises, households can make up to four times the poverty level — or as much as $69,680 a year for a 2-person household — and still qualify for some level of assistance. Additionally, there is now no income cap on some level of help if the price of the second-lowest-cost silver plan (the benchmark plan used to determine tax credits) is more than 8.5% of a household's income.

The American Rescue Plan also provided extra aid for many temporarily displaced workers or others needing health coverage before they are covered by Medicare at age 65.

Backers of the Affordable Care Act said the number of insurers offering plans next year and rate reductions by some in competitive markets proves the program is working seven years after Americans first began enrolling for individual coverage under the health exchange marketplace.

Despite Republican efforts to end Obamacare, more than 3% of all Tennesseans are insured through the individual exchange market, and the law sets standards for nearly all other people insured through other private and government plans, including a prohibition against denying coverage for those with pre-existing conditions.

The share of uninsured residents in Tennessee has dropped from about 13% of the population before the Affordable Care Act was implemented to about 10% today, even with the upheaval caused by the pandemic, Johnson said.

Questions about open enrollment?

You can contact the Tennessee Department of Commerce and Insurance at 1-800-318-2596 or visit Healthcare.gov.

Consumers will also have at least two insurance choices of health exchange carriers in all 95 Tennessee counties. Most plans, including all BlueCross plans, offer telehealth services to allow patients to get medical advice over the phone.

"We wish the state would expand its Medicaid coverage, but even as one of the 12 states that haven't expanded Medicaid, Tennesseans still need this coverage, and we know that ACA has made a real difference," Johnson said.

To enroll for the full year of 2022 under one of the health exchange plans, individuals must sign up by Dec. 15. The federal government is providing another month for enrollment this year, until Jan. 15, but those who sign up after Dec. 15 will not be eligible for coverage until Feb. 1, in most instances.

Huffaker urged consumers to talk with agents to find out which health care plans include the coverage they need for their doctors and prescriptions and to shop around for the best price.

"Make sure you check your physician network and prescription formularies because they do vary from plan to plan," he said.

Contact Dave Flessner at dflessner@timesfreepress.com or at 423-757-6340.

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