10/11/2013
Aaron CarrollLast night, I saw a tweet from Sarah Kliff on how healthcare.gov had opened a place to do “window-shopping” in the exchanges. I was excited about this, as I’ve been trying to look at options in Indiana for informational purposes only. While I’ve been able to get an account in the Indiana exchange, I’ve still be unable to see any actual offerings in the exchange. I’m as frustrated by this as many of you.
So I wandered over to this information-only area, and what do you know! It worked! I was able to see offerings from three insurance companies for catastrophic, bronze, gold, and silver plans. There were more than I expected, to be honest. There wasn’t any information about deductibles, co-pays, and co-insurance (or networks), but at least I could see premiums.
Silver plans for an individual range from $278 to $301 a month (before subsidies). This is far less than what the state released a while ago. For a family like mine, silver plans range from $938 to $1018 a month (before subsidies). What’s more, even the gold plans range from only $1175 to $1329 a month.
Since we know that the average employer sponsored health insurance plan for a family in the US is $16,351, that means the most expensive gold plan on the exchange, at $15,948, is cheaper. Let me say that again: The most expensive plan I could find for a family line mine on the Indiana Health Insurance Exchange is less expensive than the average employer sponsored health insurance plan in the US.
There will be plenty of RATE SHOCK stories in the next few months. Keep this in mind when you read them.
by David C on October 11th, 2013 at 09:41
I haven’t looked at the Indiana site, but I did spend some time on Oregon’s. There, you can see quite a lot of detail about the plans on offer, including deductibles, copays, coinsurance, and excluded services.
Its been a couple of years since I had employer coverage, but it looks to me that even the Gold plans have higher deductibles and out-of-pocket costs than many employer-sponsored plans. One has to be careful in these comparisons.
On the other hand, the silver plans on offer in Oregon have premiums about the same as the (partially subsidized) plan I could get as an early retiree from my former employer. So this seems like a pretty good deal.
My general impression is that the amount of choice is pretty daunting, and that people with little previous connection to health insurance will have a tough time navigating through the details to make a choice. At the same time, I doubt that ANY of the choices is all that bad (compared to being uninsured), and that if you end up with the 2nd best or 3rd best option you will still be in very good shape.
by matt on October 11th, 2013 at 10:02
Yeah but what are the deductibles? $300 a month is all well and good for a silver plan but does it have a several thousand dollar deductible which essentially adds several hundred a month?
I am finding it hard to weed through all of the news articles and such about this, because either someone ignores the deductibles or they focus only on the deductibles – I feel like we need the true cost.
by Matthew on October 11th, 2013 at 11:20
The plans are regulated, so you can’t end up with a $10,000 deductible labeled as a “silver plan.” Ive seen slightly different figures on this so I guess there’s some wiggle room for specific plans, but in general what I’ve seen is bronze plans have had around $5,000 deductibles and silver plans have around $2,000. Those are lower than anything I’ve seen for the same premium in the pre-ACA market.
by RC on October 11th, 2013 at 10:14
You should compare the Indiana exchange premium with the Indiana employer sponsored premium, not the national one. The figure from 2011 is $14,713, which was about 2% less than the national average. Assuming that difference carries over to 2013, the exchange and employer plans are, on average, almost identical in price.
http://kff.org/other/state-indicator/family-coverage/
by Aaron Carroll on October 11th, 2013 at 10:20
Except that it’s the average employer sponsored premium, and most expensive exchange option. Even if they’re the same… that’s a pretty big deal.
by Robert Aylward on October 11th, 2013 at 13:24
Thanks, Dr. Carroll for the link to window shopping. I suspect the decision to allow window shopping was a controversial one for the administration. I believe they made the right decision. I’ve window shopped in my state (Florida) and was surprised by the many choices available and the prices.
by Bill Huber on October 11th, 2013 at 13:39
Thanks, I think this is nice step forward however the prices they show are for 2013 and I am interested in 2014 prices. As an example http://www.healthcare.gov says the second lowest silver plan for my state and demographics is $505.84. If I go to the Anthem site which provides quotes for 2014, their second lowest silver plan is $1246.24. This is comparable to what I found on http://www.ehealthinsurance.com. This explains why the Kaiser Subsidy calculator was saying I was not going to get a subsidy one week after it said I was going to get a subsidy. It had a different estimate for the second lowest silver plan.
by Bob Hertz on October 11th, 2013 at 16:23
I have been puzzled by the trend cited here — where family health premiums on the exchange are about equal to or less than average family premiums in American corporations.
In every state that has tried guaranteed issue in the last 20 years, the guaranteed issue premiums were soon at least 20% more than corporate premiums.
Are we seeing low teaser rates this year, to be followed by much higher rates in renewal years?
I welcome anyone to comment on this. I am stumped.
by Ken Hamer on October 11th, 2013 at 23:09
I would guess (and it’s only a guess) that there is now more true competition, pushing prices lower. This may be compounded by a larger risk pool that may also drive prices lower. Even if there is not a larger pool, insurance companies may be banking on it/hoping for it.
by hipparchia on October 12th, 2013 at 00:32
“Are we seeing low teaser rates this year, to be followed by much higher rates in renewal years?”
that’s possible, and especially suspicious in the case of some of the ultra-low premiums,
but the exchange plans generally have more limited choices of doctors and hospitals, and the places where the truly, expensively sick people get care – community health centers, academic medical centers, public hospitals, children’s hospitals – are being left out of these networks.
http://pnhp.org/blog/2013/09/23/new-york-times-exposes-the-injustices-of-private-insurers-narrow-networks/
http://www.pnhp.org/news/2013/october/seattle-childrens-hospital-excluded-from-most-exchange-plans
so the expensive people will get their insurance elsewhere and the exchanges can mostly sell cheaper policies to mostly healthy people.
by hipparchia on October 12th, 2013 at 00:37
http://healthaffairs.org/blog/2012/03/16/implementing-health-reform-the-reinsurnace-risk-adjustment-and-risk-corridor-final-rule/
also, the federal govt has established reinsurance, risk corridor, and risk adjustment programs to help “stabilize the experience of these plans over the first three years when insurers will have a difficult time predicting exactly how to set their premiums.”
two of these 3 programs are supposed to end after 2016, so I guess we’ll see then….
by David M on October 12th, 2013 at 01:53
The states may have had guaranteed issue, but they probably did not have the mandate or subsidies. I have to assume those are having some effect.
by hipparchia on October 12th, 2013 at 00:12
“Since we know that the average employer sponsored health insurance plan for a family in the US is $16,351, that means the most expensive gold plan on the exchange, at $15,948, is cheaper. ”
yes, but
1. 16351-15948=403 or about $33.50/month cheaper, or about 2% cheaper. according to kff.org’s state health facts, Indiana’s medical spending is about 2% less than the u.s. average.
2. the u.s. average would include families living in expensive states like new jersey, where the most expensive gold plan is $1476/mo (according to my spreadsheet) which would be $17,712/year.
3. reading through the report you linked, gold plans actually seems to be less generous than the average u.s. employer-provided plan, so why would you be surprised that it’s also a bit cheaper?
by Jim Otto on October 12th, 2013 at 09:27
Something that concerns me is that at least in North Carolina the prices for the plans that show up on healthcare.gov for Blue Cross do not match the prices for plans that show up on Blue Cross web site.
For example:
Bluecare Bronze $5500 deductible
HealthCare.gov $197
BCBSNC.com $282
Blue Advantage Platinum $500 deductible
Healthcare.gov $340
BCBSNC.com $486
These are all for 2014 plans, and I got the info from the price shopping portal entering only age (under 49 for healthcare.gov, 46 years old for BCBSNC) and county (I chose Swain County as it is a lightly populated county in the mountains which would be expected to have some of the highest rates). It may be that healthcare.gov’s site needs to add more specific age info to close the discrepancy.
by bob hertz on October 12th, 2013 at 15:20
Good comments by Hipparchia.
A limited network plan will attract a person who is uninsured but healthy.
(That was me about 5 years ago. I could not have cared less about the size of the network I was joining. All I cared about was a premium I could afford.)
This is sex-distinct to some extent. Males like me think of health care as helicopters that will airlift from the ski slopes to a hospital in a crisis.
Women think about monthly appointments that they must keep.
(see an article by Adam Gopnik and Malcolm Gladwell on this trend.)