Uninsured and insured alike want to know: What will it cost to buy health insurance on the new Health Insurance Marketplace established by the Affordable Care Act?
By DIANE STAFFORD
The Kansas City Star
The answers depend on individual circumstances, such as age, family and income, as well as plan choices and geographic location.
With all of the computer problems plaguing the federal rollout, its been impossible for most users to find the answers, so The Star has produced a database showing the ACA policies being offered in the five-county Kansas City metropolitan area. (See below.)
Shopping for coverage on the marketplace involves choosing a plan from either Blue Cross and Blue Shield of Kansas City or Coventry Health and Life, the only two insurers offering Affordable Care Act plans for this region.
Even that isnt an either/or choice. For consumers in the five-county metro area alone, there are 86 policy variations offered by BlueKC and Coventry. Some plans have more hospitals and doctors participating than others. Plans vary in cost and coverage levels. Plans carry gold, silver, bronze or catastrophic designations, based on requirements set by the reform law.
A 27-year-old individual in the Kansas City area can find in the graphic monthly costs of $84.79 to $324.46, ranging from the least coverage to the richest. A 50-year-old might find a monthly price range from $144.50 to $552.95, also based on plan differences.
The graphic shows these monthly costs the premiums for these sample consumers.
But they may not reflect the final costs of whatever plan you buy on the marketplace. You may be eligible for government subsidies that will lower your premium in the form of federal tax credits. These credits are income-based, phasing out as income rises, and require detailed information.
Experts warn not to shop for a plan based on premiums and subsidies alone. Premiums are just the beginning of health insurance costs.
Consumers need to study what each plan includes. That involves co-payments required for office visits; deductibles that the consumer has to pay first, consumers costs and out-of-pocket maximums before insurance coverage takes over; and percentage of personal responsibility for costs after the deductible is met for such things as emergency room visits or inpatient hospitalization.
Consumers also should note the difference between in-network and out-of-network costs. Costs are lower for using hospitals and doctors that have agreed to accept lower in-network reimbursements from the insurers.
The BlueKC plans, for example, are divided between Blue Select and Preferred Care Blue plans. Generally, Select plans are about 15 percent less expensive than the Preferred Care plans. Select plans have only seven Kansas City area hospitals as in-network providers, compared to 19 in the larger Preferred Care network.
Coventrys ACA plans have an in-network of 20 hospitals in the metro area, and possibly 21, depending on the outcome of current negotiations.
Whats the attraction for buying health insurance on the federal marketplace instead of just calling up any insurance broker?
Under the ACA, consumers may be eligible for federal tax breaks essentially subsidizing the cost of buying health insurance if they qualify based on income but they must buy their policies through the online marketplace to get the subsidy. The online marketplace is at www.healthcare.gov.
Understanding what a specific policy covers is a complex exercise. Expert advice from an insurance broker or other health care expert is recommended to find out what is a good deal for you.