This post was updated Dec. 14 at 9:30 a.m. to note that Maryland extended enrollment until Dec. 22.
Gene Kern, 63, retired early from Fujifilm, where he sold professional videotape. "When the product became obsolete, so did I," he says, "and that's why I retired."
Kern lives in Frederick, Md., and has been an enthusiastic enrollee in Maryland's health exchange since it began in 2014. But this fall he received a letter from his insurer explaining that the cost of his policy's premium would jump from $800 a month to $1,300 in 2018.
Premiums have risen for many 2018 policies, though most people won't actually have to swallow those higher costs, because subsidies have gone up, too. Gene Kern is one of the exceptions.
"Because of my income, I am slightly above the 400 percent poverty level," he says, "and as a result I get no subsidy from the government."
So Kern has switched to an HMO plan on the insurance exchange for around $900 a month. That's more than 20 percent of his income, which comes partly from Social Security and partly from his retirement account. But, he says, "It's the best I can get," and he wants very much to stay insured for the next two years, at which point he will qualify for Medicare.
Louise Norris is a health insurance broker and analyst in Colorado. She says there are a number of people like Kern who earn too much for a subsidy and will pay more for health insurance next year than they did in 2017. "Rates are high," she says. "There's no way to sugarcoat that."
But she warns her clients against the temptation to get a less expensive plan that doesn't comply with the minimum standards set out by the ACA.
"It seems like a good deal because it's cheap," Norris says. "But then you find yourself being that person who has a heart attack and needs triple bypass. And hundreds of thousands of dollars later you wish you had that ACA-compliant plan."
Prices for ACA-compliant health policies went up in Tennessee, too, where state regulators approved average rate increases ranging from 20 to 40 percent.
Brenda Linn has already been paying $750 a month just to cover her own medical needs; so the retired kindergarten teacher and her husband logged on to HealthCare.gov to check the price of 2018 plans. To her surprise, the website brought up a great deal.
"And I'm like, 'Dave, this has to be a mistake,' " she says. The price Linn was quoted was less than $5 a month. Why? A slight loss of income had made her eligible for a subsidy for 2018. "Because we didn't qualify last year, I wasn't really that hopeful," Linn says.
But a large majority of marketplace shoppers do get subsidies. And for 2018, on aggregate, these subsidies are larger.
Tony Garr, a volunteer application assistant with the Tennessee Health Care Campaign, says more than ever this year, people should shop around on the exchange to see what kind of subsidies they may be eligible for.
"Generally speaking, they will find out that help is there," he says.
Any many people who got a price break in the way of a subsidy in the past can get even more for their money this year.
For example, Daniel Prestwood, who is self-employed and cleans fish tanks around Nashville, says he found a better plan for 2018, with monthly premiums that dropped from $300 to $200. He says he tries not to get too frustrated by the political wrangling over health care.
"All I know is that for 2018 I'll have a good health care plan in place," he says, "and that's the best I can hope for at this point."
And even with the Trump administration's efforts to hobble the ACA, in Tennessee, the number of applications processed by federally funded insurance guides — known as navigators and certified application counselors — has already surpassed last year's. As of early last week, with 10 days left in open enrollment, more than 1,200 individuals had applied with official help, eclipsing the total from all of 2016, when the enrollment period was several weeks longer.
While application assistants only work with a tiny fraction of the 235,000 Tennesseans who have marketplace plans, Sandy Dimick of Family and Children's Services Nashville, says she expects total enrollment will exceed last year's total, as well. Navigators around the U.S. have worried that cuts to the federal advertising budget in 2017, and a lack of cheerleading from the White House, could drive down enrollment.
Take note: Though enrollment for most states ends Friday night, residents of nine states (California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, New York, Rhode Island and Washington) and the District of Columbia have slightly more time to sign up.
This story is part of NPR's reporting partnership with local member stations and Kaiser Health News. Selena Simmons-Duffin, a producer at NPR's All Things Considered, is working temporarily with NPR member station WAMU, as part of an exchange program at the network. Blake Farmer can be found on Twitter @FlakeBarmer.
STEVE INSKEEP, HOST:
Tomorrow is the deadline in most states for people to buy health insurance on the Affordable Care Act exchanges - a law still in place despite Republican efforts to dismantle it. So as open enrollment ends, we have reporters in two states, Maryland and Tennessee, reporting on how the sign up is going. And we start with Selena Simmons-Duffin in Maryland.
SELENA SIMMONS-DUFFIN, BYLINE: Gene Kern is 63 and lives in Frederick, Md.
GENE KERN: And I spend most of my day chasing my dog around the house.
SIMMONS-DUFFIN: He retired early from Fujifilm. He sold professional videotape.
KERN: When the product became obsolete, so did I, and that's why I retired.
SIMMONS-DUFFIN: He's been an enthusiastic enrollee in Maryland's health exchange since it started in 2014. But this fall, he received a letter from his insurer. It said that for 2018, the cost of his premium was rocketing up from $800 a month to $1,300 a month. Although premiums went up in many places for 2018, most people won't actually have to swallow those higher costs because subsidies went up, too. Gene Kern is one of the unlucky ones.
KERN: Because of my income, I am slightly above the 400 percent overall poverty level, and as a result, I get no subsidy from the government.
SIMMONS-DUFFIN: So for next year, he's downgrading.
KERN: It's only an HMO plan, and even then, it's going up to $892 a month.
SIMMONS-DUFFIN: That's still more than 20 percent of his income, which is fixed.
KERN: It's the best I can get.
LOUISE NORRIS: Rates are high. There's no way to sugarcoat that.
SIMMONS-DUFFIN: Louise Norris is a health insurance broker and analyst in Colorado. But for people like Kern, she warns against the temptation to get a plan that doesn't comply with the minimum standards set out by the ACA.
NORRIS: It seems like a good deal because it's cheap, but then, you know, you find yourself ending up being that person who has a heart attack and needs triple bypass, and hundreds of thousands of dollars later, you wish you had the ACA-compliant plan.
SIMMONS-DUFFIN: Gene Kern feels lucky in one way. Medicare is just two years out. Until then, he's just glad to have insurance and the peace of mind that gives him. I'm Selena Simmons-Duffin in Frederick, Md.
BLAKE FARMER, BYLINE: I'm Blake Farmer in Nashville, Tenn., where people who buy insurance on the federal marketplace were pretty nervous. This year, state regulators approved average rate increases ranging from 20 to 40 percent. Brenda Linn is already paying $750 a month just to cover herself. So the retired kindergarten teacher and her husband logged on to healthcare.gov to see how bad the damage was going to be.
BRENDA LINN: And I'm like, Dave, this has to be a mistake.
FARMER: For her silver-level plan, the quote was less than $5 a month. A slight loss of income made her eligible for a subsidy.
LINN: Because we didn't qualify last year, I wasn't really that hopeful.
FARMER: A large majority of marketplace shoppers do get a break, and the subsidies are considerably larger this year. That's because the subsidies rose along with any premium increases. Volunteer application assistant Tony Garr says more than ever this year, people should shop around on the exchange to see what kind of subsidies they may be eligible for.
TONY GARR: Generally speaking, they will find out that help is there.
FARMER: Those who've gotten a break in the past are finding that it goes further. Daniel Prestwood is self-employed. He cleans fish tanks around Nashville.
DANIEL PRESTWOOD: This time of year, winter, when you're running your heat a lot, it makes the water evaporate more.
FARMER: Prestwood says he found a better plan and still had his monthly premiums drop from $300 to $200. He tries not to get too frustrated by the political wrangling around health care.
PRESTWOOD: All I know is that for 2018, I'll have a good health care plan in place, and that's the best I can hope for at this point.
FARMER: While enrollment for most states ends Friday night, eight states and the District of Columbia have slightly longer for folks to sign up. For NPR News, I'm Blake Farmer in Nashville.
(SOUNDBITE OF SUN GLITTERS' "DEEPER INSIDE")
INSKEEP: That story is part of a reporting partnership with NPR, local member stations and Kaiser Health News.
(SOUNDBITE OF SUN GLITTERS' "DEEPER INSIDE") Transcript provided by NPR, Copyright NPR.