« UPDATED: Late launch of Spanish healthcare website fuels conservative Hispanic campaign | Main | As enrollment deadline for Jan. 1 coverage nears, a survey finds uninsured still unprepared »

Under the hood, new health insurance plans strike some as 'same old'


If you receive health insurance benefits from an employer, chances are you're not familiar with individual health plans. They've always been more expensive, with higher premiums, deductibles and out of pocket costs, because their market share and actuarial pools are smaller. The Affordable Care Act is supposed to make the individual market more like the employer market so everyone can have and afford health insurance. But as more consumers explore their options on the healthcare exchanges, some say the plans are more like the costly old individual plans than they had hoped, the New York Times reports. 

"Insurers devised the new policies on the assumption that consumers would pick a plan based mainly on price, as reflected in the premium," writes NYT. But as Hollywood insurance agent Lois Feinberg advises, the value of a plan is in the doctors and formulary (prescription drugs) it covers for your individual needs.  

With 35 years in the business, Feinberg tells people to shop for a plan whose copays you can afford. On the individual health exchange, the copays are better than they used to be -- for example, if catastrophe strikes, the most you would have to pay under the ACA is $6,400 before your costs are covered 100 percent -- but they still cost much more than most employer-sponsored plans.   

In one NYT example, a 35-year-old couple chooses the cheapest exchange plan offered by Blue Cross Blue Shield. The premium is under $300 a month for both of them, but the deductible is over $12,000. The premiums get higher with each year of age -- it's always been that way but the ACA limits how much higher -- but peoples' incomes don't necesasrily track with these higher ates. 

The problem with achieving parity between the employer and individual market for health plans is the pool. If a balanced proportion of young and older people enroll, theoretically, the ACA will achieve its goal of creating a pool that looks more like the employer's pool; one they can cover at an affordable price. 

Can parity between the two pools be achieved in practice? It's too early to tell. But because employers can increasingly green their pools, individuals may continue to pay more for healthcare. 

If your household income is below 250 percent of the federal poverty level, you can get help paying your out of pocket costs as well as your premium. To get this subsidy, you'll need to enroll in a Silver plan.  

Although the new health plans do make individual insurance less expensive, will the consumers who are required to purchase them find them affordable? We'd like to hear what you find. Read more. 


Feed You can follow this conversation by subscribing to the comment feed for this post.

The comments to this entry are closed.