You
In healthcare news, affordable care act premiums are expected to increase sharply when people enroll starting in November. Insurance companies are making their projections now for 2026 rates. In Wisconsin, nearly 850,000 people are enrolled in ACA plans.
12 insurers across the state that offer marketplace plans project increases ranging from 6.6% to 34.5% according to health system analysts.
What's driving this increase? We turn to Caroline Gomez-Tom, an enrollment manager with the covering Wisconsin program, which helps people sign up for marketplace plans. And thanks very much for being here.
Thanks for having me, Frederica. So when you saw these projected premium hikes, what was your reaction, especially to the like 34.5% increase?
Yeah, it was definitely a startling hike, except we weren't necessarily surprised knowing that there were some things that were in the mix regarding enhanced premium tax credits that were going away or potentially going away.
You know, Congress could still act in, you know, these several months before the end of the year.
And then some other policy changes that have happened at the federal level, plus healthcare costs, rising inflation, et cetera, that could be a part of this.
But to see the numbers that we are expecting for this year, it, it took, it took your breath away.
Yeah, so these enhanced tax credits are due to expire at the end of 2025. How did those tax credits help with out-of-pocket costs?
Yeah, so these extended tax credits, they have been in place now since 2020, and essentially they expanded really the discounts or the, the, the amount that people qualified for to lower their cost of insurance.
Especially for those folks that had slightly higher income. So will that middle income range above 400% of the federal poverty level?
And what that means is that people had more options to consider when they were looking at the healthcare.gov options, instead of just going directly to the lowest costing bronze plan with a crazy out-of-pocket cost for an individual,
they could actually shop around realistically and look at the plan that may cost a little more per month, but because of those extended premiums, they could afford it, but had also lower out-of-pocket costs for them.
And then especially for those higher income folks, middle income folks, they could enter the marketplace probably for the first time since it existed and not have to depend on other short-term insurance type plan options and have full coverage.
And so did those premium tax credits encourage a lot more people to actually enroll?
Absolutely. And we can see that even just this last year where we hit a milestone year in enrollment in Wisconsin, we had 313,000 people sign up, which was the highest we'd seen since the marketplace opened in 2014.
So according to an analysis that we read, there are other drivers other than these enhanced tax credits of rate hikes, like the cost of healthcare itself, which you mentioned, including specialty drugs, like OZMPIC.
What's it like for people with ACA plans to see such swings in costs?
Yeah, I think it's tough because we're already talking about folks who otherwise don't have access to another form of coverage.
These are folks that don't qualify for Medicaid. They usually do not have an option for health insurance through their employer.
So they're already going to healthcare.gov because there are limited options for them.
And then without this additional financial assistance to help lower the cost of insurance, and sure, there still will be some tax credits for most folks, but there still will be some that really will get priced out of the marketplace.
And that's very difficult for folks to go without health coverage.
Because also what happens to the marketplace itself if people don't enroll because they really can no longer afford it?
Well, and this is something that we saw, you know, in the early years of the marketplace where the health systems were still trying to figure out kind of where their sweet spot was for pricing is that if not enough people were signing up and joining and enrolling in plans,
then you end up with the people that need health insurance, like they have chronic illness.
They have conditions that need regular healthcare.
And so then they'll pay what they have to in order to get the care that they need.
But then healthier folks that still need care that still could end up and realistically may end up in the emergency room because they are without health insurance and they've waited.
They will just hold off from signing up for a plan just because they're deterred by cost.
So if someone is enrolling or reinrolling for next year, what is your advice?
Well, I would say to start early, get connected with a health insurance navigator covering Wisconsin still has our navigator program and we will help people sign up for coverage through healthcare.gov.
They can call 2-1-1. They can also reach us directly on Whiskover.com or our website covering wi.org to sign up for an appointment and they need to shop around.
And I normally would say they should shop around, but really this year, I think it's a need to make sure that they understand all the options that are available to them so that they can make a sound choice because what I don't want to see are people just for going,
even going to health care.gov because they're deterred by cost.
We want people to at least know what their options are so they can make a sound decision.
Great advice. Caroline Gomez-Tom, thanks very much.
For more on this and other issues facing Wisconsin, visit our website at pbswisconsin.org and then click on the news tab.
That's our program for tonight. I'm Frederica Fryberg. Have a good weekend.
Thank you.