Keiser Health News asks
“How is a consumer to make sense of this?”
KHN answers with some
straight talk worth considering: “Most policy analysts concur that average
premiums will go up for younger, healthier people – and that they will get
better benefits than they do now – but that rates may fall for older or sicker
Americans, as new rules go into effect Jan. 1. Increases may be
offset for many of those buying coverage through tax credits available to
people with low and moderate incomes.”
Finally, consider these 5
things when you evaluate anticipated cost of coverage in your state:
1. Comparing apples to apples is virtually impossible.
The first thing to
understand is that policies that will be sold to individuals and small
businesses in online marketplaces are brand new and must cover a range of
essential benefits that were not always covered in the past. That includes
prescription drugs, hospitalization and maternity coverage. Consumers cannot be
turned away or charged more because of health problems, as they can now in most
states. Women cannot be charged more than men. In addition, the amount
you'll have to pay out of pocket will be capped at $6,350 for singles or
$12,700 for families. Currently, almost a third of individual policies
have caps that exceed those amounts, according to a report by Kaiser Health News and
U.S. News & World Report.
2. Look for which premiums state regulators
are using for their comparisons. Under the health law, coverage sold through
new marketplaces to individuals and small businesses include a range of types,
from the lowest-cost bronze plans that have the highest deductibles to
higher-premium platinum or gold plans, where you pay fewer out-of-pocket
costs. But premiums are just one part of the cost of health
insurance. When considering a report on rates, ask which type of coverage
was highlighted and how much the deductibles and co-payments are. Was it
the low-cost bronze plan price, the slightly higher priced silver plans or the
highest priced platinum or gold? Or some combined average?
3. You are not
average. Many
of the estimates are based on averages, which really don’t reflect what any
individual consumer will pay. Premium prices will vary based on a person’s age,
where they live and the insurer they select. Generally, younger people –
especially those few who are buying high-deductible coverage now -- may see
an increase in premiums, while older or less healthy people may see their rates
go down.
4. Subsidies will offset
costs for many people. Most
people shopping in the new marketplaces are expected to qualify for a subsidy
to offset part of the cost of the premiums. Sliding-scale subsidies
will go to those earning between between about $11,590 and $46,000 a year, as
individuals. Those who get subsidies will also likely pay a portion of their
household income – from 2 percent to 9.5 percent – toward the premium cost.
5. Last, but certainly not least - premium changes are
unlikely to affect you at all. The rates submitted to states and the federal
government are for coverage sold to individuals and small businesses with
fewer than 50 workers that are not self-insured. Currently, the vast
majority of Americans with insurance coverage get it through their jobs – and
they generally work for companies with more than 50 workers. Large firms
already offer coverage similar to what the health law will require insurers to
offer individuals and small firms, so little change is expected. The new
rates are most likely to affect people who buy their own coverage. About 15
million do so currently and an estimated 7 million more are expected to do so
next year because of the health law.
No comments:
Post a Comment