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Local insurers, agents break down ACA, explain why prices continue to soar

Posted at 8:55 AM, Nov 16, 2016

GRAND RAPIDS, Mich. -- Nearly seven years ago, the Affordable Care Act was signed into law. The goal was to expand and improve healthcare across the nation, but according to millions of Americans, it's done anything but that, costing many right here in West Michigan more money.

The Obama administration recently confirmed premiums will go up sharply next year for the millions of people receiving health insurance through Healthcare.gov. Frustrated insurers are placing part of the blame of rising prices on the healthy and young avoiding enrollment.

Yet, just one day after Donald Trump's presidential election victory, more than 100,000 people visited Healthcare.gov and signed up for plans. The U.S Department of Health and Human Services says it was the strongest day of Obamacare signups of this year's enrollment period so far.

Health insurance agent Greg Westcott calls it a million-dollar question: "Why do insurance premiums keep going up?" Priority Health's Amy Miller says those rising costs are an issue across the board.

Insurers are set to raise premiums by an average of 22 percent for the benchmark Silver Plan in 2017, costing an average of just under $300 a month.

"We’re not seeing the young and healthy enroll in the ACA plans like we had hoped, [and] healthcare costs continue to rise, especially around pharmacies," Miller said.

Experts say 85 percent of consumers won't notice the increase, thanks to federal subsidies. Those subsidies, we're told, are rising alongside the premiums to shelter most consumers from sticker shock.

"I’ve got clients that are getting the subsidy that are complaining about the amount of the raise they have to pay," said Westscott. "I think when it gets to that point, you have to realize this thing has gotten out of control."

Experts blame the price hike on less competition. Nearly 28 percent of carriers are leaving Obamacare's government-run market.

But Priority Health and Blue Cross Blue Shield say they're standing behind it.

"I understand why some of them decided to do this," said Rick Notter, the Director of Individual Business at Blue Cross Blue Shield of Michigan. "They're losing a significant amount of money. We've been fortunate in that we have not experienced losses that other carriers have."

While your premiums rise, insurance agents are losing out as well. Their commissions are being reduced.

FOX 17 asked Priority Health and Blue Cross about the agent cuts. They say they are paying agents as much as they can and that it's another factor of rising costs.

"When the ACA went into effect, one of the rules set forth was that 80 cents of every dollar that we take in at premium has to be paid out in claims, so that only leaves 20 cents on the dollar to take care of all of our other administrative costs. As a result of that, we had to cut the amount we pay for agents," Notter said.

Both insurance reps agree: Agents play a major roll in helping clients navigate Healthcare.gov, explaining plans, finding deals and signing consumers up. Plus, their service to you is free.

The Department of Health and Human Services says more than 75 percent of marketplace consumers using Healthcare.gov will be able to find a plan costing $100 or less after subsidies.

If you're looking to save money on insurance this year, experts suggest trying a limited network, which means you choose a specific health system and seek care within that network. Though there are fewer options for treatment in such plans, you can significantly reduce costs.

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