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Health Insurance Alert! Confusion in Local Health Insurance Market Causes Concern

Charlottesville area residents who re-enroll at the Affordable Care Marketplace for 2019 are in for some big surprises given recent changes in health plan options.  Those who do not visit the Marketplace before December 15 deadline may be upset to learn that they have been “auto-enrolled” and locked into new plans with high prices and/or a limited choice of doctors and hospitals.

After two weeks of open enrollment, volunteer insurance counselors at local agencies are reporting many puzzled clients faced with discrepancies between the premiums included in a letter from their current insurance company and the actual prices on the Marketplace.

“I met with a Nelson County resident who is paying $246 per month for a Silver Plan this year. He received a notice from his insurer that with financial help from the Marketplace his premium would be zero in 2019,” says Joe Bernheim, an insurance counselor at the Jefferson Area Board of Aging (JABA).  Checking on-line the man discovered that his actual monthly premium would be $452.  He also learned that the 2019 plan no longer included all his doctors.  After reviewing all his options, he was able to select a Gold plan for $295 per month with all of his doctors included.

Another client who recently visited JABA’s Insurance Counseling Office was paying $49 per month in 2018. The estimate for 2019 in a letter she received in October was for zero premium, but with further research she learned her actual premium would be $83 monthly.  She ended up selecting a plan with a different company that did have a true zero net premium.

“Many clients come in with their automatic plan renewal letters wondering if they really need an appointment this year,” says Jack Hanrahan, who assists with Marketplace enrollment at Legal Aid Justice Center.  “We explain that, while this letter meets the official regulatory requirements, it does not reflect the reality of 2019 Open Enrollment.  This fall, we have competition in our insurance region and our job as ACA counselors is to make sure consumers understand all their options and make informed choices.  We want competition to work for insurance buyers.”

In 2018, the only insurance company offering plans in the Charlottesville area had a network that included most local physicians and both hospitals.  Some 2019 plans have more limited networks. Many Marketplace enrollees have received a renewal notice with a new plan name that includes the term ‘Select’.  “This sounds benign,” says Heather Rowland who volunteers at JABA.  “Yet if that enrollee goes to the insurance website, he/she finds the statement ‘Most doctors and facilities in UVA Health System network are not in the Select network’. We think consumers need to be aware of this loss of choice in 2019 while they still have time to look at alternatives.”

On January 1, 2019 expanded Medicaid begins in the region. Many low and middle income families will be eligible for free health insurance through Virginia’s “New Health Coverage for Adults.”  Those who become eligible for this program will no longer be able to receive financial assistance through the ACA Marketplace.  In this situation it is important to return to the Marketplace both to sign up for the new program and to discontinue Marketplace Coverage as of January 1, 2019.

There is still time before the December 15 deadline for consumers to select the best health insurance for themselves and their families for next year. Those who wish to explore ACA Marketplace options can go on-line to, or call the Marketplace at 800-318-2596, or request free local counseling at JABA (434-817-5248) or at Legal Aid Justice (434-977-0553).  Information about the New Health Coverage for Adults from Virginia is available at local Departments of Social Services or by calling Cover Virginia at 855-242-8282.


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