Premiums Unveiled For Health Overhaul Plans

[Stinkum]

Premiums Unveiled For Health Overhaul Plans
by The Associated Press

With new health insurance markets launching next week, the Obama administration is unveiling premiums and plan choices for 36 states where the federal government is taking the lead to cover uninsured residents.

Before tax credits that work like an upfront discount for most consumers, sticker-price premiums for a mid-range benchmark plan will average $328 a month nationally for an individual, comparable to payments for a new car.

The overview of premiums and plan choices, released Wednesday by Health and Human Services Secretary Kathleen Sebelius, comes as the White House swings into full campaign mode to promote the benefits of the Affordable Care Act to a skeptical public. Congressional Republicans, meanwhile, refuse to abandon their quest to derail "Obamacare" and flirt with a government shutdown to force the issue.

Sebelius stressed the positive in a preview call with reporters. Consumers will be able to choose from an average of 53 plan options when the new markets open Oct. 1 for people who don't have health care on the job.

"For millions of Americans, these new options will finally make health insurance work within their budgets," she said.

A report by her department estimated that about 95 percent of consumers will have two or more insurers to choose from. And the administration says premiums will generally be lower than what congressional budget experts estimated when the legislation was being debated. About one-fourth of the insurers participating are new to the individual coverage market, a sign that could be good for competition.

But averages can be misleading. When it comes to the new health care law, individuals can get dramatically different results based on their particular circumstances.

Where you live, the plan you pick, family size, age, tax credits based on your income, and even tobacco use will all impact the bottom line. All those variables could make the system hard to navigate.

For example, the average individual premium for a benchmark policy known as the "second-lowest cost silver plan" ranges from a low of $192 in Minnesota to a high of $516 in Wyoming. That's the sticker price, before tax credits.

In the three states with the highest uninsured population, the benchmark plan will average $373 in California, $305 in Texas, and $328 in Florida. Differences between states can be due to the number of insurers competing and other factors.

"One surprise is Texas," said Larry Levitt of the Kaiser Family Foundation. "That is a state that has put up roadblocks to implementation, but the premiums there are below average."

The second-lowest-cost silver plan is important because tax credits are keyed to its cost in local areas.

But consumers don't have to take silver. They can pick from four levels of coverage, from bronze to platinum. All the plans cover the same benefits and cap annual out-of-pocket expenses at $6,350 for an individual, $12,700 for families.

The big difference is cost sharing through annual deductibles and copayments. Bronze covers 60 percent of expected costs; silver, 70 percent, on up to platinum at 90 percent. Bronze plans have the lowest premiums and the highest cost sharing.

The administration report found that factoring in tax credits, a 27-year-old making $25,000 a year would see the premium for the benchmark silver plan drop to $145 in nearly every state. But if that hypothetical young adult used the tax credit to buy the cheapest bronze plan, he or she could cut the monthly premium to $74 in the Dallas-Fort Worth area, $102 in Orlando, and $119 in Pittsburgh.

For a family of four making $50,000, the tax credit would cut the monthly premium for the benchmark silver plan to $282. But if the family used its tax credit to buy the cheapest bronze plan, the premium would be $26 a month in Dallas-Fort Worth, $126 in Orlando, and $209 in Pittsburgh.

In the Washington, D.C., metro area, the hypothetical family could find a zero-premium bronze plan, while the lowest an individual could get after applying their tax credit would be $66.

Such differences are sure to leave many people scratching their heads. Officials said they're due to complicated interactions between the tax credits and insurance company pricing strategies in dynamic markets.

Another outside analyst said the administration analysis of premiums is consistent with what the 14 states running their own insurance markets have reported.

But Dan Mendelson, president of the market analysis firm Avalere Health, said the focus on premiums is too narrow. "The analysis doesn't account for cost sharing," Mendelson said. "This is a limitation." To get an idea of the true cost of coverage, consumers have to add up premiums and their expected out-of-pocket costs.

"Consumers are going to need to shop," Mendelson added. "Sometimes a silver offering doesn't cost much more than a bronze."

He added two other caveats: Be ready for significant cost sharing, and check carefully that your doctors and nearby hospitals are in the plan's network.

Starting Jan. 1, virtually all Americans will be required to carry health insurance or face fines. At the same time, the health care law will prohibit insurance companies from turning away people in poor health, or charging them more. And it will limit what insurers can charge their oldest customers.

Experts say the plans under the health care law are not comparable to what's currently sold on the individual health insurance markets, because the coverage is broader and the financial protection for policyholders is more robust.

Obama is directly engaging in the promotional campaign for the health care law. Tuesday, he and former President Bill Clinton talked health care during a session sponsored by Clinton's foundation. And Obama is planning a speech on the law on Thursday.

In response to the administration's premium and plan-choice information, a spokesman for Senate Republican leader Mitch McConnell, R-Ky., said that premiums that are "lower than projected" are not the same as "lower than they are now."

"The White House is making every effort possible to spin the bad news that seems to come every day, but the American people know that even this rosy scenario is not what they were promised when Democrats were ramming this bill through Congress on a party-line vote," McConnell spokesman Don Stewart said in a statement.

Also on the size of the networks:

It seems that another reason that the rates are lower — at least some of them — is that insurance companies have limited the size of their doctor and hospital networks in some of the cheaper plans.

"The lowest-cost plans are coming in a lot lower than people were predicting, because the networks are coming in with a lot fewer doctors and hospitals than people were predicting," says Robert Laszewski. He's an and longtime observer of the health care system.

Because the law requires all insurers to basically offer , varying the size of the network was about the only tool they had left to try to create a less expensive plan.

"For example, in California, the lowest cost Silver plan is one that has only about half the doctors and hospitals that particular health plan has in their standard employer network," says Laszewski. Silver is the among bronze, silver, gold and platinum.

Laszewski says that for people who are currently uninsured, these more limited network plans will probably be just fine. But for people who have been buying their own insurance, or if they've had employer-provided insurance, they're likely used to having a freer choice of doctors and hospitals. And they're going to find that comes with a price.

"You're going to have to pay $100, $150 a month more than that to be able to get access to those kinds of networks," he said.

[MrSparkle001]

Get ready for the shitstorm.

All the plans cover the same benefits and cap annual out-of-pocket expenses at $6,350 for an individual, $12,700 for families.

You know what that is for a healthy individual? Worthless. Spending all that money every month and you still have thousands in out-of-pocket expenses.

If you have a preexisting condition that prevented you from getting care, or a chronic condition that's costing you more than $6,350 per year, you will make out well. If you are young and healthy and don't have insurance, you could be fucked. Those without health insurance also tend to be the ones who can't easily afford the extra monthly expense of premiums. Even with tax credits it's an extra expense forced on them, to preserve the insurance companies' profits. As if working class monthly budgets aren't already stretched thin...

This is going to be good. The labor unions are starting to bitch now but the shitstorm hasn't even started yet.

[runlvlzero]

Insurance companies in America are 100% corrupt.

Health insurance companies in America are 2000% corrupt. Might as well be a case for logans run.

Social health care can be debated. The evil nature of American hospitals and insurance is not really up for debate in my mind lol.

[Stinkum]

Yeah, I don't understand how some people are happy about this. The plans for these have outrageous deductibles, extremely small networks, high co-pays, and we are FORCED to buy them.

Originally Posted by MrSparkle001

Those without health insurance also tend to be the ones who can't easily afford the extra monthly expense of premiums.

The big unanswered question. I don't personally know any single people or families who didn't or couldn't afford to buy health insurance before that suddenly have a few extra hundred dollars a month to throw around now.

Originally Posted by MrSparkle001

If you are young and healthy and don't have insurance, you could be fucked.

According to the Kaiser ACA premium calculator , a single, nonsmoker age 45 earning $8,000 a year (part time minimum wage job or a full time job bartending/waitressing) in a state that did not expand Medicaid would have to pay 50% of their income towards health insurance.

[runlvlzero]

Originally Posted by Stinkum [You must be logged in to view images. Log in or Register.]

According to the Kaiser ACA premium calculator , a single, nonsmoker age 45 earning $8,000 a year (part time minimum wage job or a full time job bartending/waitressing) in a state that did not expand Medicaid would have to pay 50% of their income towards health insurance.

For little to no benefit to the individual other than making it easier for the government to subsidize treatment at hospitals while some white collar rich ass with several insurance worker certifications rolls around in a paycheck that trickles up to the CEO's pleasure palace out of country.

I'm so glad this is what I have to look forward to for the rest of my life.

IMO the best option would be to let us all rot without insurance but force this measure on anyone who makes over $400,000 USD yearly. Make them pick from these plans and bar all other insurance. You know because those rich asses are so valuable and important to our society. We couldn't have them getting sick on top of their piles of cash.

Even better force the Congresscritters and president to take the bronze plan by default. To save on government spending.

***Income number used as arbitrary as the numbers for these insurance plans, nothing personal.

****At least currently for this very moment I'm an out of work "veteran" with no income who is a dependent. This means I have access to tricare free of charge. Wonder if there is a loophole somewhere for me?

[Tiddlywinks]

Nobody forces people to buy this. The tax "penalty" for not purchasing a plan is typically much less than the health insurance premiums are. The tax penalty ends up being, I believe, a max of 1%-2.5% of annual income, whereas the premiums are loosly based around 4-8% of an anual income.

Additionally many people can be exempt. The situation where the guy earns $8,000 per year and the premium would end up costing him 50% of his income is FALSE.

Anytime the premiums end up being over a given threshhold (I think it's currently 9%) that person can apply and will get exemption from needing to purchase the plan.

[Tiddlywinks]

For example, the tax "penalty" for a 27 year old single individual making $25,000 anually only comes out to like $625 per year.

This website generally has answered any question I've had regarding the process. Here's a link to the tax penalty for those who chose not to be covered bit: http://obamacarefacts.com/obamacare-tax-penalty.php

[JayN]

Originally Posted by Tiddlywinks [You must be logged in to view images. Log in or Register.]

Nobody forces people to buy this. The tax "penalty" for not purchasing a plan is typically much less than the health insurance premiums are. The tax penalty ends up being, I believe, a max of 1%-2.5% of annual income, whereas the premiums are loosly based around 4-8% of an anual income.

Additionally many people can be exempt. The situation where the guy earns $8,000 per year and the premium would end up costing him 50% of his income is FALSE.

Anytime the premiums end up being over a given threshhold (I think it's currently 9%) that person can apply and will get exemption from needing to purchase the plan.

Your ruining these racist assholes negroid dreams let them keep on hating.

[Tiddlywinks]

Originally Posted by Stinkum [You must be logged in to view images. Log in or Register.]

According to the Kaiser ACA premium calculator , a single, nonsmoker age 45 earning $8,000 a year (part time minimum wage job or a full time job bartending/waitressing) in a state that did not expand Medicaid would have to pay 50% of their income towards health insurance.

Here's the bit about exemptions btw. No clue what you're talking about really. This guy in your example would be exempt like 3 different ways.

http://obamacarefacts.com/obamacare-...on-penalty.php

About ObamaCare Tax Exemptions

The mandate's exemptions cover a variety of people, including: members of certain religious groups and Native American tribes; undocumented immigrants (who are not eligible for health insurance subsidies under the law); incarcerated individuals; people whose incomes are so low they don't have to file taxes (currently $9,500 for individuals and $19,000 for married couples); and people for whom health insurance is considered unaffordable (where insurance premiums after employer contributions and federal subsidies exceed 8% of family income).

[Stinkum]

Originally Posted by Tiddlywinks [You must be logged in to view images. Log in or Register.]

The situation where the guy earns $8,000 per year and the premium would end up costing him 50% of his income is FALSE. Anytime the premiums end up being over a given threshhold (I think it's currently 9%) that person can apply and will get exemption from needing to purchase the plan.

Hence, leaving him without any insurance.

I'm not sure why this is a "good thing" to you.

That was my whole point that went entirely over your head. How is the person in the state with no Medicaid expansion going to pay for their insurance? They get no subsidies. No Medicaid. But they can pay 50% of their income towards buying insurance through an exchange. For 7 million of the poorest working Americans, that is their only option for insurance. These are the people earning minimum wage at part time jobs. The ones whose hours have been reduced. Whose employers do not offer insurance.

It seems to me that the most humane option is to plug the Medicaid gap by allowing those earning under the poverty level to get subsidies. Why punish the working poor for being "too poor"?