• Getting better estimates for insurance costs in the exchange, Indiana edition

    Success! I finally got into the full website. So things are improving.

    Here are some options I’ve found. I’m not going to list the insurance names because I don’t want to push one company over another.

    There was a nice silver option for me, that would let me continue to see my doctor. The plan for me would cost, $362 a month (or $4350 a year). It has a $1500 deductible, and an out-of-pocket maximum of $6350. The co-pay for a primary care doctor is $20, and there’s a $15 co-pay for generic drugs. The co-insurance is 15% after the deductible.

    On the other hand, I could get the gold plan from the same company for $432 a month (or $5187 a year). It has a $700 deductible, and an out-of-pocket maximum of $3000. The co-pay for a primary care doctor is $15, and there’s a $10 co-pay for generic drugs. The co-insurance is 10% after the deductible.

    For the record, again, the average employer sponsored health insurance plan in the US costs $5306. The average annual deductible is $1135. So a gold plan in the Indiana exchanges that seems pretty good to me costs less than the average employer sponsored plan in the US.

    RATE SHOCK!!!

    @aaronecarroll

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    • ‘Rate shock’ = what it costs for Aetna to keep current profit margin on individual plans. Hence, Mark Bertolini takes his ball and runs crying home, no Aetna on exchanges. Don’t let the door hit you!

    • Aaron, I’m glad you posted this — I found some very similar patterns between what I can get on the Texas exchange in Harris County (where I currently live) and my old University of Michigan Insurance, which I am about to get kicked out of. I didn’t do the same level of in-depth research of that you did into each plan, but looked at the ranges of prices in each band and compared them against Michigan’s using the metal level as a rough proxy for level of service. They were quite competitive. Granted, there are plenty of caveats, but it’s still an eye-opener.

      http://themakeshiftacademic.blogspot.com/2013/10/health-exchanges-employer-insurance-vs.html

    • Is this an apples to apples comparison? I did a search on Michigans site and found that silver and gold level premiums are roughly $775-$1,400 for my family of four. I pay about $500 per month through my work (they kick in a percentage).

      What is the early word nationally on insurance costs? Are they going down? Or up? My Teaparty cousins are claiming their premiums are increasing 55% as a result of the ACA. What do you think? Legit or BS?

      Also, unfortunately last week I was captive to Glen Becks radio show and he mentioned a number of places that were cutting jobs as a result of the ACA (including Central Michigan University and a number of large medical centers). What do you think? Real or fake?

      • There’s NOT a 55% rate ave increase for near identical plans. However there are many such increases (and more) folks are reporting vs their current plans which do not include some ACA-mandated provisions. Those happy with their current non-ACA compliant plans are the ones most likely to get hurt by large premium jumps.

        Only time (next few yrs) will tell how ACA might affect overall HC costs, if at all.

        No question that ACA has affected jobs. Many firms (inc some health systems, school districts) have stated they are cutting hours to stay under magic 29hrs when HI becomes mandatory. Others are avoiding new hires altogether. IMHO- Obama’s non-legislative delay of mandate enforcement could just as easily be reversed so firms are not taking chances.

        • There are anecdotes about cutbacks in hours. However, if you look at actual BLS data, the numbers are not showing it.

          Steve

        • Actually, the umber of full time jobs is rising with respect to part time. Here is an explanation from the well known socialists at the American Enterprise Institute:

          And here’s additional jobs analysis

          http://www.politico.com/story/2013/08/obamacare-isnt-destroying-jobs-95239.html

        • FWIW, the ACA is nothing other than a godsend for small businesses. The idea that it will hurt small businesses or employment by small businesses is ridiculous in the extreme. Something like 96% of US businesses employ less than 50 people, and they have a horrific time providing health care for their employees (since they can’t get in on group plans that large companies use, a company’s costs can skyrocket if they have one or two seriously ill employees). Most don’t, and many small business owners don’t even have health insurance for themselves. The number of small businesses near the 50 employee limit is tiny, and the ACA will mean that it’s much easier for small companies to provide insurance for their employees should they want to.

          This is covered well in the following article.

          http://www.newyorker.com/talk/financial/2013/10/14/131014ta_talk_surowiecki

          It concludes with:

          “The U.S. likes to think of itself as friendly to small businesses. But, as a 2009 study by the economists John Schmitt and Nathan Lane documented, our small-business sector is among the smallest in the developed world, and has one of the lowest rates of self-employment. One reason is that we’ve never had anything like national health insurance. In a saner world, changing this would be a reform that the “party of small business” would celebrate.”

          • Since most businesses get conflicting advice from many sources who do you think is more likely to be correct for any specific business? (One has to remember that businesses that are stupid or take stupid advice generally fail.) The editorial writer that might be basing at least part of his conclusions based upon his own personal ideology or the successful businessman?

            I’ll place my bets on the successful businessman at least in the areas of that businessman’s expertise.

            • It sounds like you’ve never run a small business, and have never had to live without insurance.

              Having run a small (very small) business for the last 25 years, I can attest that that article rings quite true. Here (Japan), I have affordable health insurance that won’t kick me off if I get sick or leave me bankrupt if my spouse gets cancer. It costs me about US$4,000 a year. Covers dental, too. My friends who have gone back to the states and try to go it alone report living in abject terror of health problems for themselves and their families; even while paying more than what they pay in rent in insurance premiums. The statistic that most small business owners don’t have health insurance for themselves or their families is a horror unknown in any other industrialized country. These aren’t just fly-by-night translators. These are the MIT and the like educated computer nerds who work 80-hour weeks to build their companies until Apple or Microsoft buys them out and tells you what wonderful technology they provide (which actually happened to several of my fellow mid-70s generation MIT grads). Maybe I’m overly irritated because I was in that demographic, but small businesses really are important to the US economy, and pre-ACA, life was a real horror for these people. It was a crime how the US treated its small business owners.

              So, to reiterate: the US health insurance situation pre-ACA made it irrational in the extreme to start a company. ACA fixes that, and that’s enormous for someone thinking about going out on their own or starting a company.

              Another thing: all the ACA complaints refer to companies with around 50 employees _that hire part time workers_. So that’s a tiny percentage of companies. Also, 50 employees is a lot of employees. That’s well over what one thinks of as a “small business”, and at least in the pre-ACA US, a company that large really ought to be providing health insurance benefits if it’s competing for quality workers.

            • David L: “It sounds like you’ve never run a small business”

              You are wrong about this and a bunch of other thingsD, but not only that it appears you were arguing with yourself. My comment revolved around the fact that I believe that business owners aren’t stupid so if they say that the ACA causes them to hire less full time employees or causes their costs to go up I believe them until proven otherwise. I’ll also add that I believe they know how to run their businesses better than the bureaucrats in Washington.

      • Granted — Texas to Michigan may not be apples to apples, but both the prices I looked at in Texas and the premiums I quoted for UM were for single adults. (though remember the age profiles differ a bit) Covering a family of four’s baseline rates (before UM’s kicks in its share) ranges between $1,235 and $1,637 — pretty similar to what you’re getting on the exchanges.

        Living in Central Michigan might get you different options than those in Washtenaw County shown below (for a single 34-year old.)

        Bronze $154-$271
        Silver: $199-300
        Gold: $258-$372
        Platinum: $371

        Not too shabby in comparison to UM plans (though again, not exactly apples to apples)

        Also — don’t forget about the subsidies.

        As for Glenn Beck, he’s making no sense. There’s no reason why Central would lay off people cause of the ACA — if anything it gives them more flexibility to retain staff or hire more. At UM, our union actually gave the administration a concession on health care for the satellite campuses because we realized that grad students could probably get Medicaid or a highly subsidized exchange plan. Administrators got a bit of cost savings, but grad employees still maintained access to decent health insurance.

    • I am really surprised that we have not seen some simulations of how these policies actually affect annual health care spending. Without knowing the OPC limits on employer plans it would seem possible that total amounts spent on health care could be significantly higher for exchange plans.

    • No rate shock. It’s likely comparing apples to oranges. HMO (Exchange info from your quoted rate & practice location) vs PPO (typical employer plan), your age less than ave age of employer-covered US worker, health differences in (predicted) Exchange population vs employer sponsored population, etc.. Also- Under GAAP most US companies typically report ave health care cost per worker as their total HC expense divided by # of workers. However this total corp expense also includes retiree health care, which approx 25% of large firms still offer, employee wellness programs, etc.

      BTW- Congrats on being one of the few to access Healthcare.gov with complete success. I still have not been able to finish an application to gain access to full shopping info on the various Plans. So I still don’t know which Exchange Plans (if any!!!) would allow me to continue seeing my current doc.

    • “There was a nice silver option for me, that would let me continue to see my doctor.”

      Do Americans have any idea how freakishly bizarre that sounds to Canadians (and I presume to everyone else in the industrialized world)?

    • This is why I don’t get very high deductible plans. The difference between the gold and silver options is $837, which is only 37$ more than the difference between the deductibles. I presume this is the actuarial value.
      If you think there’s a chance you’ll spend $1,500 in a year (less than the last broken limb cost me) you’re better off with the gold plan.

      I’d get a very high deductible plan if people paid $20/month for it, but most ideas offered seemed to raise the deductible to something quite high, but not reduce the cost that much, which always made me think that actuaries had nothing to do with them.

      • I’ve always purchased high deductible plans and never in my life (I’m 65 now) have I ever come close to the deductible in my health spending.
        For me (relatively healthy) and many others, high deductible (cheap) plans are a bargain.

    • Anecdotes: It’s all a matter of selection; location, age combined with what one is getting. Many university folk get better deals in their locals than the unwashed masses because of their positions and the people that surround them. I’ve seen that over the years and took note of university folk that had HMO’s that treated them far better than many of the rest. Those attached to medical schools frequently seemed to get a better deal at least on the surface.

      On the other hand if the resultant plans from the ACA are that good there would be no reason to prevent other private plans from being created. Who would choose the inferior private plan?

    • Rates are really high for those over 55. In California, my rate would be $800/month for a bronze plan, $900/month for a bronze plan that lets me keep my doctor, and $1000/month for a silver plan. And I’m not a smoker. Same out-of-pocket limit (about $6K). For perspective, I have a pre-existing condition that would render me completely uninsurable pre-ACA. Fortunately, I’m still covered by my husband’s employer plan.

      • Those are the numbers we are currently seeing for the two of us (54 and 55, minimal medical history) on the exchange in CA, but since we are paying $1250 per month for COBRA (on the private market the number would be higher) we are happy! The number s sound high, if you aren’t considering what percentage your employer kicks in. Nationwide the big employers pay an average of about 75% of health insurance costs. Although we have both had PT this year, we are yet to hit our deductible.

    • While I agree with Dr Perry’s main point (AEI link) that monthly variations in BLS stats are too volatile to draw firm conclusions, the real rate of PT workers today is likely much higher than BLS counts.
      BLS employment surveys define FT as working 35 hrs/wk TOTAL, not 35hrs at single job. Many are now getting those hrs by combining 2 (or more) PT jobs to get their weekly hrs. So one worker working 25hrs at job A + 15hrs at job B shows up in stats as FT for BLS data, but is NOT “FT” (benefits-eligible) under ACA. This analysis also also ignores the increasing # of discouraged who have stopped looking for work during past 4 weeks. Total Labor Participation Rate is way down during past few yrs (despite a progressive INcrease among older workers (65+)). Since discouraged workers are now more likely to typically re-enter work force as PT when they do come back, this also may tend to under-count recent PT vs FT stats.

      http://www.bls.gov/cps/cps_htgm.htm

      You can search BLS demographics data (inc historical) here-
      http://www.bls.gov/cps/demographics.htm