ALL OTHER STATES: You may qualify for a 60-day Special Enrollment Period (SEP) if you've recently lost (or will soon lose) your employer-based healthcare coverage, or if you've experienced other Qualifying Life Events (QLE) such as getting marrinew yorked/divorced, moving, giving birth/adopting a child, getting out of prison, turning 26 etc. For these SEPs you may have to provide documentation to verify your QLE. Visit HealthCare.Gov or your state's ACA exchange website for details on the process.
The total number of Individual Market enrollees is 33,982 enrollees as of the end of January. It's important to understand that this is not the same as the number of people who enrolled on the ACA exchange during Open Enrollment, for two reasons: First, 2020 OEP in Vermont ended on December 15th, 2019; this data is as of January 31st. Second, the tables below include both on- and off-exchange enrollees, as opposed to on-exchange only.
Last March I wrote an analysis of H.R.1868, the House Democrats bill that comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.
Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or make improvements in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.
The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".
*(Yes, I know, the District of Columbia isn't actually a state, and Vermont's mandate is...well, read on...)
As the 2020 Open Enrollment Period rapidly approaches (it starts November 1st nationwide...except for California, where open enrollment is starting on October 15th), it's time to start getting the word out about some important things to keep in mind this fall.
One of the most critical things to remember for residents of California, the District of Columbia, Massachusetts, New Jersey, Rhode Island and Vermont is that each of these states* has reinstated an individual healthcare coverage mandate law/ordinance to replace the federal ACA mandate penalty which was zeroed out by Congressional Republicans back in December 2017. This means that if you live one one of them, unless you receive an affordability, hardship or other type of acceptable exemption, you'll be charged a financial penalty when you file your state/district taxes for 2020 in spring 2021 if you don't have qualifying healthcare coverage.
But that's not all! In addition to the actual 2018 MLR rebates, I've gone one step further and have taken an early crack at trying to figure out what 2019 MLR rebates might end up looking like next year (for the Individual Market only). In order to do this, I had to make several very large assumptions:
Vermont is the fourth state to announce their approved 2020 ACA individual/small group market premium rate changes. VT (along with Massachusetts and DC) has (wisely, in my opinion) merged the risk pools for the two markets into one, meaning I have to plug the numbers in differently on my spreadsheet.
Back in mid-May, my initial analysis of the two carriers participating in both Vermont markets put the weighted average rate increase being requested at an even 13.0% statewide: Blue Cross Blue Shield of VT was requesting a 15.6% increase, while MVP Health Care asked for a 9.4% bump.
For comparison, here's a similar state-level pie chart from the Vermont Agency of Human Services. It doesn't start out too bad, breaking out the total statewide coverage along the lines of the Donut. As you'd expect, around half the state's 627,000 residents are covered via private insurance (45% via their employer, 5% via the ACA individual market, 1% via "Association Health Plans"), while the other half is mostly covered via Medicare or Medicaid. Vermont has only a 3% uninsured rate.
Last May, I noted that Vermont was supposedly joining Massachusetts, New Jersey (and later in the year, the District of Columbia) in reinstating the ACA's Individual Mandate Penalty, which added an additional tax to people who don't enroll in ACA-compliant healthcare coverage (whether private or public) and who don't qualify for an exemption due to an affordability threshold, hardship or some other qualifying reason.
Strike One:Vermont's mandate won't go into effect until 2020, leaving a one-year gap. This bill getting signed is still good news, but mostly irrelevant for 2019. The "coordinated outreach efforts" part is really more of a counter to the Trump Administration's slashing of the ACA's marketing/outreach budget...but not really, since Vermont already runs their own exchange and should have their own marketing/outreach budget anyway. So this is more of a token gesture, I'd guess.
It's important to note that the numbers posted in the tables below include both Vermont's on and off-exchange enrollees in the individual and small group markets. It's also important to note that Vermont (like Massachusetts) merges both the individual and small group markets into the same risk pool for purposes of premium rate settings.
There are four tables...two for the Individual market (raw numbers and percentages) and two for the small group market. Perhaps the most noteworthy line is the "Reflective Silver" enrollments...those are people who took up the "Silver Switcharoo"...basically, unsubsidized individual market enrollees who switched from (or chose) on-exchange Silver plans to off-exchange Silver plans to save money on policies which are identical to the on-exchange Silver version but without the CSR premium load.