David Smith, center, with Independence Blue Cross (IBC) discuses the opening health insurance exchange and provides information on health car reform to George Allen Tuesday, Oct. 1, 2013, at IBC’s mobile education and enrollment center in Philadelphia. (AP Photo/Matt Rourke)
Last week, the White House and the US Department of Health and Human Services announced that the cost for health insurance that uninsured individuals are required to buy under the Affordable Healthcare Act would average 16 percent less than before here in Pennsylvania.
That comparison, however, was made against what the Congressional Budget Office calculated rates might look like in 2016, not against the actual plans available prior to Oct.1 when enrollment began.
A rough comparison between those earlier 2013 plans and the ACA rates, made by the Manhattan Institute using the HHS data, yielded a different result with statewide premium rates for a 27-year-old male ranging from a 36-percent decrease in Colorado to a 279-percent increase in Nebraska. In this analysis, the average increase in Pennsylvania is 63 percent.
Firstly, only individuals not currently covered by an employer-based policy, Medicare, or government insurance policy must enroll for ACA coverage between Oct. 1 and March 31, 2014. The ACA mandate requiring businesses with more than 50 employees to offer insurance to all those working more than 30 hours per week was delayed for one year by President Obama.
Because everyone’s individual costs are dependent on family size, income and whether or not those seeking coverage smoke, only generic comparisons can be made. Costs are also dependent on the type of policy purchased: Bronze, Silver, Gold, Platinum or Catastrophic. (Catastrophic coverage is only available for individuals under 30, or older individuals who can demonstrate extreme hardship. It covers major issues like extreme trauma from an accident or cancer treatments, but routine expenses like office visits or x-rays are all paid out-of-pocket.)
Pennsylvania did not set up its own healthcare exchanges for purchasing ACA coverage, opting instead to have the federal government run them.
In its announcement last week, HHS revealed that Pennsylvanians could purchase ACA coverage from a variety of providers, depending on where they live. Pennsylvania is divided into nine Rating Areas. Pittsburgh is in Area 4.
Using the HHS rate calculator at http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/datasheet_home.cfm, one can see that in Zone 4, there are four providers offering a total of 41 plans: five Catastrophic, eight Bronze, 13 Silver, 14 Gold and one Platinum. You can plug in your age and find the monthly premium costs for least expensive policy in all categories.
For instance, a 27-year-old will pay monthly premiums of $103.69 for the cheapest Catastrophic plan, $119.19 for Bronze, $133.83 for Silver and $169 for Gold. For a 40-year-old the costs range from $126.45 for Catastrophic, $145.35 for Bronze, $163.20 for Silver, and $206.09 for Gold. For a 64-year-old, the monthly cost of the cheapest Catastrophic policy is $296.82, Bronze is $341.19, Silver is $383.10, and Gold is $483.78.
If you lived in Area 8, that same Gold policy would cost $715.83 per month.
These policies also have deductibles and co-pays, which generally vary inversely with the level of coverage. High premium policies pay more of the covered costs, which mean lower deductibles. Bronze policies cover 60 percent of costs, Silver 70 percent, Gold 80 percent, Platinum 90 percent.
The ACA caps annual out-of-pocket expenses at $6,350 for an individual and $12,700 for families. The ACA also provides subsidies for individuals and families with incomes between 100- and 400-percent of the federal poverty level.
To calculate your specific costs go to www.healthcare.gov or call 800-318-2596. This is the federal healthcare exchange site. Though its health plan information page gives an error message saying the dataset is private, which does not allow you to compare plans, you can—and if you are uninsured, you must—open an account and enroll between now and March 31.
The site can also link you to healthcare navigators and community health resources to help with the process.
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