New Rate Information – Preliminary

Yesterday, the government released some of the information regarding the health insurance rates that will be available on the new exchanges.  I encourage you to compare the information that is readily available through the multiple articles to the cost of your own insurance and see how much you will be affected.  I will go through some examples given in a Chicago Tribune article where specifics of the scenario are given.  Unfortunately, the family of four example doesn’t give specific ages of the adults so that example is pretty much worthless.  Also, I am using zip code 60159 so your particular situation may be different.

Single 30 year old:

  • ACA Bronze plan (least expensive plan) is $136 with no subsidy.  There is no detail given as to coverage (deductible, copay, etc.) or size of network but the max out of pocket for all ACA plans is $6,350.  There will be many plans with very small networks of in network coverage.
  • Current available plan for a healthy (preferred) person:  HSA 100 with a $6000 deductible and 100% coinsurance.  In English, this means that the persons maximum out of pocket would be $6000 for the year so it is slightly better than the ACA maximum and this plan has a large network of doctors that provide in network coverage with the ability to have in network coverage nationwide.  This plan would cost 108.16.

So the increase would be about 25% with the information given.  The big question with these quoted rates is the size of the network and how important this is to you.  Some of the networks could be smaller than the county you live in and may only include a very small network of doctors to choose from.  If you have ever had HMO coverage, think that size of network or possibly smaller.

Let’s take the next example, 55 year old couple:

  • ACA plan would be $533 with all the same qualifications I gave above except the family out of pocket max is $12,700.
  • HSA 100 plan with the exact same plan as above, except the deductible would be $12000 for the family, would be $416.84.

This increase is 28%.

These increases don’t seem so bad do they?  The things to watch out for are your doctor choice limitations (size of network for in network coverage) and your portability of in network coverage for when you travel.  If you are tempted to choose a plan with a small network, make sure you understand what your potential liability will be if you are forced to find coverage that is out of your network.

On a personal note, I wonder if people with different insurance will be treated differently.  Have you ever been asked what insurance you have prior to making a doctor’s appointment and/or specifically asked if you have HMO coverage?  I have spoken frankly with the people making these appointments when asked this question and in my particular situation, I was being given lower priority due to my HMO coverage.  A lot of these new ACA plans will be HMO, or managed care, type coverage.  I have been there and done that and will never do it again.  Of course, HMO coverage is better than no coverage, so for people with no insurance, it is certainly a better and lower cost option than going without.

I will be back with more information after the exchanges… or… errr…  sorry, government changed the name to marketplace.  So, I will be back with more information after the MARKETPLACES open for business.  I encourage you to understand fully your health insurance options.  Know what is happening with your current insurance going into 2014, know what your options are for the remainder of 2013 and how that changes in 2014 whether buying on or off the MARKETPLACE, and know what your penalty/tax will be if you choose to be insured through non-compliant plans or choose to be uninsured.

Please let me know if you have any questions.  I would be happy to help.  As always.  more to come…

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