NEW YORK (MainStreet) Now that I have circumvented the Healthcare.gov website and completed my application old-school via snail mail, I am ready to buy health insurance. But, without a processed application, the system isn't ready for me.
Premium prices shown incredibly misleading
As I found out first-hand, the Healthcare.gov "see plans now" tool is not helpful at all.
"It is largely useless and misleading to consumers because the sample premium prices shown are most likely not accurate and it displays no other plan comparison information," says Jonathan Wu, C.E.O. of Valuepenguin.com, a consumer finance site that specializes in helping consumers make decisions about insurance. His company easily built an exchange plan comparison tool to show more accurate premiums and plan specific benefits based on location, exact ages, income and family size, which includes any likely subsidies applied.
The main problem is the Healthcare.gov "see plans now" tool only offers two age options: Under 49 or over 50.
"Consumers don't know that the sample prices shown by the tool are really based on someone age 27 for the first option, and someone age 50 in the other," Wu said. "Actual premium prices depend on exact income, age and family size and will most likely be very different once your application is processed."
In this case, someone 45 years old will pay substantially more than some aged 27, and someone whose family size is larger than the sample of four will also see higher actual premiums. The same goes for the age samples in the other family options. Also, the Healthcare.gov tool does not show any subsidies applied, so consumers may experience premium sticker shock that is not warranted.
Two things that do not affect premiums are health status and gender.
Deductible sticker shock is real
According to the Healthcare.gov tool, most plans offered in my county are from the BlueCross BlueShield of Florida, which shows a benefit and cost chart for each plan on the company website. That's when a new sticker shock hit me: ridiculously high deductibles for Silver plans. Healthcare.gov clearly explains that Bronze plans likely have lower premiums and higher out-of-pocket costs and that Platinum plans have the highest premiums and lowest out-of-pocket costs. The deductibles listed on most of the Silver plans were in the $11,000 range for a family and in the $6,000 range for singles (and only $1,000 less for the highest-priced Silver plans), almost as high as the maximum out of pocket costs for the plans. That's only affordable if you don't use the plan at all and never pay it.
I called up Florida Blue at the 800 number and spoke to customer service agent Danielle Anderson, who very patiently explained that any eligibility for a premium subsidy might also bring further "cost-sharing" reductions in the deductibles (specifically for Silver plans, according to Healthcare.gov), which also depend on the processed application.
Wu explained that if you know you will be using and needing healthcare services, it might pay to look at the higher-tier plans for more comparison. When I checked and compared Gold to Silver in Florida using the Valuepenguin.com plan comparison tool, the yearly deductibles were half (around $5,000), and the monthly premiums were approximately $150 higher (paying $1,800 more per year) for a net savings of around $3,200, if I needed to use a lot of healthcare services. Wu suggested comparing all tier options and noted that some states have new healthcare co-ops offering insurance, such as Kentucky, where Platinum plan premiums are actually lower than other Silver plans offered in the state.
Compare more than just premium prices
President Barack Obama promised (among other things) Healthcare.gov would be an easy way to compare and buy health insurance plans. But Wu says the majority of consumers who have not had health insurance recently may not be aware of all they need to research and compare beyond premium prices to choose a health plan that will make financial sense for them.
"I've heard some doctors who fear that consumers may not be able to pay their share at the point of service, because they don't understand what their share of the cost actually is and how the high deductible works," says Wu.
I also asked Florida Blue's Anderson how to compare exact costs of services when comparing plans that just list "10% after deductible" on the chart. Anderson said if planning on costs was something important to me, I should look at "predictable cost" or "all co-pay" plans. But while those are easier to compare and plan for, the Silver premium costs are at the highest end of the chart, and the deductibles were still $10,000. Wu says sometimes these fixed provider charges can also be higher than in coinsurance plans.
After my experience, I know that premium price (what you pay for your health insurance plan, usually monthly) is not the most important factor in choosing from among the many plans that may be available. Here's what else you need to compare among all the tier plans:
- Co-insurance: Your share of the costs of a covered health care service, calculated as a percentage (say 20%). For example, if the health insurance plan's allowed amount for an office visit is $100 and you've met your deductible, your coinsurance payment of 20% would be $20. Your plan pays the left-over $80. If you haven't paid the full deductible yet, you pay the whole $100. Ditto for any other services and costs.
- Cost-sharing: The share of costs covered by your insurance that you must pay out of your own pocket which usually includes deductibles, coinsurance and copayments.
- Cost-sharing reduction: An income-based discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance and copayments. You can only get this reduction by applying through the Marketplace and only if your income is below a certain level and you choose a health plan from the Silver plan category. But you won't know what it is until your application is completed and processed.
- Copayment: A fixed amount you pay for a covered health care service, payable at the time you receive the service. For example, $15 for an office visit.
- Deductible: The amount you owe for covered health care services before your health insurance plan begins to pay, per year. For example, if your deductible is $11,000 for a family, your plan won't pay anything until you've already paid $11,000 in covered medical costs. This is an important number if you feel you and/or your family will need to use a lot of health care services that are above the free preventative wellness visits, because you will be paying this amount out of pocket, every year.
- Participating provider list: These providers have contracted with the health plan to provide services. If you would like to keep seeing your regular doctors, don't buy a plan until you check its provider list. Then, call up the doctor's offices to double-check participation in any plan you are considering.
- Out of Network: This lists your costs for using providers outside of the plan network of providers. Some plans do not provide any out of network benefits at all.
Wu says if you need information, call up the insurance companies directly as I did. He gave me another hot tip: health insurance agents are a great source of information about how all the plans work and can help you evaluate and choose a plan on the exchange. Also, don't be afraid to call up doctor's offices and ask what the likely charge is for office visits and other services so you can plan for your costs.
Overall, my self-employed, 56-year-old brother was satisfied with his purchase of a Silver plan for his family of four through the New York State exchange, while I am still waiting n Florida for my application to be processed through Healthcare.gov. While he is not eligible for subsidies in New York State, he is federally eligible and can apply through another link on the New York State exchange.
But he's not rushing. "I'm paying $1,500 per month on Cobra now for our family insurance so of course I'm thrilled about paying $1,100 for an exchange plan, subsidies or not," he said.
President Obama also promised these plans would be affordable. Your mileage will most likely vary.
--Written by Naomi Mannino for MainStreet