MORGANTOWN — Open enrollment for Affordable Care Act 2023 plans began on Tuesday, and several West Virginia healthcare advocates spoke to the press to tout the ongoing benefits of the ACA and the new and expanded benefits of the Inflation Reduction Act.
“It’s so important to have access to affordable, high-quality healthcare,” said Sen. Ron Stollings, D-Boone and a physician practicing in Madison. People who can’t afford their medications, such as insulin, will ration out or entirely skip doses, endangering their health. “It’s a great day, I think with the expansion.”
As explained during the press conference, the IRA addresses healthcare costs in several ways:
- It gives Medicare the power to negotiate lower drug prices for future years. Beginning in 2026, 10 drugs will be negotiated with that number increasing to 15 drugs in 2027, and 20 drugs in 2029 and into the future. By 2030, more than 80 drugs will be eligible for Medicare price negotiation, in addition to insulin products.
- It will cap out-of-pocket spending for seniors. Medicare Part D out-of-pocket costs for prescription drugs will be capped at $2,000 per year beginning in 2025. Out-of-pocket spending can be smoothed over the course of the year beginning in 2025, so patients are not forced to pay the entirety of their out-of-pocket cost all at one time.
- It caps insulin copays for Americans on Medicare at $35 per month.
- It prevents pharmaceutical companies from raising Medicare drug prices faster than the rate of inflation beginning in 2023.
- It extends enhanced premium tax credits for another three years.
- It requires that families pay no more than 8.5% of their income towards coverage. It requires that no American with an income at or below 150% of the federal poverty level buying their coverage on the Marketplace will pay a premium.
Dr. Jessica Ice, executive director of West Virginians for Affordable Health Care, said, “For me, a single mom, and for so many West Virginians and Americans, passage of the Inflation Reduction Act is a game-changer. … In my home, it means saving more than $200 a month on health insurance premiums.”
Jeremy Smith is director of the West Virginia Navigator program, which receives federal grants to provide free ACA Marketplace assistance to West Virginia residents.
One important provision of the IRA, he said, is fixing the “family glitch” of the ACA. Under the family glitch, a person offered coverage through a spouse’s workplace plan could not get ACA coverage, even if the spouse’s plan was unaffordable. Under new guidance from the IRA, a person can now opt out of an unaffordable spouse’s plan and get coverage.
Smith explained that ACA Marketplace coverage is offered for those who don’t qualify for Medicare, Medicaid or employer-based insurance. Private companies post plans on the Marketplace, and 90% of the people on Marketplace plans qualify for subsidies to reduce their premiums.
Smith also explained how enhanced premium tax credits work. When filling out a Marketplace application, the person estimates their income for the coming year. Based on that estimate plus family size, a monthly subsidy is determined and that amount is sent directly to the Marketplace insurance provider. The person is billed for the difference between the subsidy and the premium.
Then, when the person files taxes, the IRS compares estimated income to actual income and either bills the person for any difference owed or provides a larger refund.
For free assistance from West Virginia Navigator, call 304-356-5834 or go to https://acanavigator.com/wv/home or wvnavigator.com.
The organization also offers free enrollment assistance events around the state. They can be found at the Navigator website. A Morgantown event is set for noon-6 p.m. Nov. 9 at the Aquatic Center at Mylan Park. Walk-ins are welcome.
The Marketplace enrollment period runs through Jan. 15.
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