Window shopping opens and competition blooms for 2021 ACA health plans

For the first time in years, huge swaths of rural Georgia will add second, third, and even fourth insurers, guaranteeing competition and choices. A handful of metro Atlanta counties will have five companies to choose from.

And for the second year in a row, prices will rise less on average than inflation in health care, increasing 3.4%. One company’s average prices, Kaiser’s, will fall 19%. The biggest price hike will be Ambetter’s 9.8% increase, following a price decrease the previous year.

The stability follows years of turmoil, soaring prices and disappearing choices.

“I’m not surprised at all,” said Tara Straw, a senior policy analyst at the Washington, D.C.-based Center on Budget and Policy Priorities. “The marketplace is stable for insurers, and it’s looking like a good place for them to do business.”

The impact overall should be good for shoppers, she said.

“People have more choice. They have possibly more choices for more generous coverage. More choice in the market is good.”

Waiver plan to proceed

The facts are in contrast to remarks Kemp has made laying the groundwork for his plans to reshape the market. His “waiver” proposal for the marketplace has not yet been signed by U.S. Centers for Medicare and Medicaid Services Administrator Seema Verma, but she has said she supports it.

“Every week we announce new businesses coming into Georgia, but there’s no competition in private sector insurance,” Kemp said at an Oct. 15 ceremony on the waivers with Verma at the Georgia Capitol.

“Right now over half of Georgia counties have only one insurance carrier offering coverage. Many of these trends are only getting worse,” Kemp said, also noting enrollment had dropped.

However, the insurance companies had filed their 2021 coverage proposals weeks before Kemp spoke. The 2020 market also had showed stability, with two companies coming to join the four on the Georgia market then and inflation holding at less than medical inflation. At that time Kemp said he hoped part of his waiver would stabilize "a volatile marketplace.”

A spokesman for Kemp on Wednesday defended the governor’s remarks.

“More than half of counties still have only one carrier,” spokesman Cody Hall said in an emailed statement, referring to the remaining weeks of 2020.

In 2021, eight counties will have just one carrier, while the other 151 will have competition.

Kemp’s waiver proposals to remake the marketplace would be implemented in phases. A “reinsurance” program meant to lower premium prices would start in January 2022, and proposals including the one to block and reroute healthcare.gov shoppers would start in January 2023.

Insurers expanding reach

For 2021, the six companies Georgia had this year will stay, but most will expand the number of counties they serve.

Anthem, the insurance giant of Georgia’s employer plans, will add 31 counties, to cover a total of 106. Alliant, traditionally a north Georgia niche player, is expanding to 98 counties from 35. Ambetter, the national company Centene’s Georgia brand for the ACA marketplace, is adding 27 counties, coming just 10 shy of blanketing the state.

CareSource, which dipped its toe in the Georgia market for the first time this year, is adding 18 counties for a total of 62; its fellow newbie entrant Oscar Health plans to stay and retain its eight metro Atlanta counties, and Kaiser is also keeping its footprint.

“There were some wild rides there,” with price spikes and companies fleeing, conceded Mark Mixer, CEO of Alliant. Now, he said, “I think the market has stabilized.”

“We think the individual market is where the future is at," Mixer said. Explaining Alliant’s decision to stay in and even expand in the individual market: “Don’t fix it if it ain’t broke.”

Volatile history

In prior years, the Georgia market was the poster child for volatility.

At first, in 2013, insurers underestimated the prices they needed to charge. Customers were shocked to see the increase that followed. Then when insurers thought they had a grasp of the customer pool, they said that moves by GOP lawmakers to undermine the federal financing of the market and attempt to repeal it contributed to more price increases. One year one company increased rates by more than 50%.

Premium prices are still a problem for those who buy on the exchange but who make too much money to qualify for subsidies.

A family of four gets subsidies up to about $100,000 a year of household income. After that, they pay the brutal full price.

For them, said Bainbridge insurance agent George Daniel, “this does not help at all.”

The agent has other concerns, like narrowing networks: Blue Cross, also known as Anthem, suddenly lost a swath of hospitals from its network. He thinks Ambetter should have more individual providers. On the type of HMO plans available on the ACA marketplace, if a place isn’t in network, a patient might not get a penny of their bills covered.

Hall, speaking for Kemp, pointed out those high prices that the higher earners pay, and also that rural areas pay higher prices than metro residents do. If Kemp’s waiver gets implemented, the reinsurance portion of it is intended to use public money to pay some of the insurance companies' larger claims, in order to help lower those Georgians' premium checks.

But for customers who qualify for the subsidies, especially those who benefit from Ambetter’s telehealth and other special programs, Daniel said, the competition’s been a boon.

“It is good," he said. “Ambetter last year almost knocked Blue Cross Blue Shield out of the market.”

Open enrollment starts Sunday, Nov. 1, and goes for six weeks, until Dec. 15, for coverage that starts on Jan. 1, 2021.

And when it does start, Decatur County, where Bainbridge is located and Daniel works, will also have a third option, as Alliant joins the fray.

Open enrollment shopping on the Affordable Care Act’s exchange marketplace, healthcare.gov, will begin Nov. 1, and window shopping is already under way. Counties across Georgia have added new insurance options, and agents recommend shoppers look to see what’s available before they simply allow their plans to re-up. Open enrollment lasts through Dec. 15.