Why some Obamacare applicants are getting surprise medical coverage for themselves

Perhaps you’ve heard about the movie “Pence,” a liberal political documentary about Mike Pence and his controversial beliefs and policies. It’s due out in Washington next week. But if you haven’t heard, you probably do have a news item of interest. Since the inauguration, health care has gone from a top story in the new administration to a subplot, and one that’s been getting less attention than it deserves. So that’s why we thought it was worth repeating:

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The federal government has received over 15,000 applications for new Obamacare coverage this year. Nearly one-third of those have been in the Washington area. And many of the applicants are veterans and retirees.

Some of those are going to be customers of HealthCare.gov, the online marketplace where state residents can buy private health plans. In previous years, that would have been the exception. These days, however, the media frequently reports only that the health plans sent to those applicants were “coverage types” that the administration has been struggling to support.

The reality is that 1,095 applicants nationwide, or 38 percent of those applying, had COBRA. That is, their old employer plans were “coverage types” that have dropped out of the market. Under Obamacare, these plans cannot be discontinued, but they can be renewed, an option for those who lost them after 2014.

The other 9,208 applicants, or 52 percent, had Medicare Part D plans. The coverage that Medicare Part D plans provide is less generous than their non-Medicare Part D plans, but that’s not a huge problem in the Washington area because many have been offering their plans to individuals for the past several years.

The military account for another 14 percent of those applicants. Most are active-duty personnel whose doctors do not accept the government exchanges, and many could not be convinced that it was better to buy a plan with a lower-cost, limited benefit than to wait for Congress to agree to include doctors in those exchanges.

So, despite the publicity stories that focus on the 26 percent who have a direct connection to President Trump — say, having been part of his campaign staff or a current White House employee — 63 percent of the 16,426 applicants were individuals who are not political partisans or employed by the federal government. And, like other Washingtonians, they are paying less for their health care.

As for adult children: Only around 2,400, or 13 percent, have gotten new coverage. Of those, 60 percent were covered under a parent’s plan, most of those through an employer. Another 4,600, or 3 percent, of the applicants, or roughly a quarter, were covered by Medicaid.

One-third of them were children who had been grandfathered into Obamacare, while around a quarter are Medicaid beneficiaries. About 90 percent of them have their own children.

The other quarter of the applications have gone to Blue Cross Blue Shield plans, a relatively small number but growing fast in the Washington area. The growth reflects the recent court decision in North Carolina, which effectively ruled that fewer insurers offering Obamacare plans means fewer people need them.

Another 8,100, or 2 percent, are signed up through the Medicare Advantage program. That’s a fast-growing group.

Why is that important? We all know the importance of having medical coverage for ourselves and our family. And because of Republicans’ opposition to Obamacare, more and more of us are finding ourselves in this situation, because the law was never meant to serve people who rely on Medicare. Most of these people are being told that, to be able to continue to receive their Medicare benefits, they will need to sign up for a plan sold through the Obamacare exchange. That’s a big deal.

The president’s rationale for this change is that he wants to “keep healthcare premiums down” for everyone. That will be easier to do for those who get their coverage through their state-run exchange. On the other hand, it will make it tougher for those whose coverage is restricted because it is offered only to individuals or to people with Medicare. And a point we have been making for years is that it is worth knowing exactly which of these people will be affected, as well as the size of their pre-existing conditions.

All of this information is now up on our website. Go to HealthCare.gov (www.healthcare.gov), sign up, and if you are happy with your plan, and satisfied with it, you can continue to do so. But if you are not, it may be time to go back to purchasing your coverage on the individual market, as the law clearly allows. There are

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