Those who didn't have health insurance prior to the Obamacare rollout don't have an easy way to compare the costs of the new marketplace plans to existing ones. But for those who already had individual policies, there is a viable means of comparison. Count me in that boat.
Over the past three months, I've been attempting to find out if the exchange in my state (Illinois) could provide a better deal than the policy I have now. Since 2001, as an independent writer, I've been paying for an individual private policy, which is a "catastrophic" plan that only starts coverage after I've met the annual deductible of $5,800, which resets every year. I pay about $600 a month in premiums for the policy.
Of course, like most health consumers, I'd like more services to be covered because everything under the deductible is out of pocket – items for which my family is technically uninsured. So doctor's visits, tests and drugs are all cash purchases.
Depending upon the service, the insurance company will "reprice" or discount the total cost, but I still pay the bill and the mark-down isn't always significant. Hospitals rarely offer meaningful discounts and we still get hammered with $1,000 emergency-room visits.
When HealthCare.gov opened for business on Oct. 1, I was excited and tried to log on. After two months of trying – and not succeeding – I made several calls to the government's hotline and obtained some policy information over the phone.
Despite what the Department of Health of Human Services says, there are still glitches on the exchange. My last attempt to get information on HealthCare.gov last week was no more successful than my first attempt four months ago. The system told me my account was "locked or disabled." Although more than 2 million people have gotten in and applied for coverage, I was still not able to make it past the username and password page.
Back to the Hotline
After working with a HealthCare.gov representative on their toll-free call center (800-318-2596), the customer service person confirmed my technical roadblock – and couldn't fix it – so she pulled up my file and walked me through the eligibility and policy review process after verifying some personal identity information, which had held up my application for two months.
"You're not approved for the catastrophic plan," she began.
"Okay, what does that leave, then?"
"Well, I can give you details on the bronze, silver and other plans."
"Let's try the bronze plan (the second least-expensive plan)."
"First, I have to tell you that, based on your application and family income, you won't qualify for a subsidy."
"Yes, I knew that (back in October) and wasn't expecting one."
"So, because your current user name and password are blocked – and I can't unblock it – you can either set up a new account online or I can read you the policy information over the phone."
Since I had no interest in trying my luck with my online nemesis, I opted for the voice route.
"Why don't you read me some policy summaries?"
"First of all, does anyone in your home use tobacco?"
"No." This was a question on the application I completed in October through the hotline.
"Okay. Here's what we have in the bronze level (the second-lowest tier above catastrophic)."
The representative then read through a long list of policies, detailing premium and out-of-pocket costs.
At first blush, the blizzard of information was daunting. Every policy was slightly different, making them hard to compare. Some had co-payments on certain services while others didn't. Deductibles varied. It was like trying to compare oranges with asparagus.
The annual deductibles were mostly at the $12,700 level. Getting all of this information over the phone is not particularly helpful because you can't graphically compare it side by side. This was the least consumer-friendly way of doing this, so I focused on a low-premium plan and a strategy for gauging the premium/out-of-pocket cost allotment.
I zeroed in on a Blue Cross/Blue Shield plan with a $712 monthly premium. Out of the gate, that was $112 more a month than I was paying currently; paying $1,344 more a year just for a premium wasn't in my game plan. But that was only part of my comparison metric.
The out-of-pocket total figured prominently in my comparison. Since I record every monthly medical expense for tax purposes, I can see what my family is spending money on; over the course of the year we spent nearly $9,000 on un-reimbursed care. Stripping out dental, eyecare and other expenses that wouldn't be covered by either plan left some $3,300.
Now I needed to calculate what would be covered under the terms of the Blue Cross plan I sampled through HealthCare.gov.
According to the representative, some 60 percent of qualified expenses would be covered until I hit the deductible. After the $12,700 threshold was exceeded, then 100 percent of expenses would be covered. So under the Blue Cross plan, I'd be covered for about $2,000 in expenses that I would normally pay cash for under my current plan.
Now, the moment of arithmetic truth: The difference between my current and proposed premium is $1,344. So, in a normal year, I'd come out slightly ahead (about $600) if I obtained a HealthCare.gov policy – figuring that the higher premium would be offset by better coverage of out-of-pocket costs.
We'd do even better if we had an expensive year, meaning more doctor and hospital visits and prescriptions. To make the comparison simple, I excluded the co-payments in this calculation, but you should include that in your final tally. Including co-payments, the HealthCare.gov plan would be pretty close to break even for my family.
As with all insurance policies, there is a lot of wiggle room on the premium. Lower premiums generally mean higher out of pocket costs.
If you're young and relatively healthy, you'd probably not only qualify for a premium subsidy, you'd have a pretty low out-of-pocket expense scenario overall. But for a growing family with middle-aged parents (lots of doctor/dental visits), you really have to do the math. Note: If we qualified for a subsidy, it would've been a slam dunk for the government plan.
I will take a closer look at the options online when I can get access, but for now I'm sticking with my present plan.
In any case, it really makes sense to look at your annual health expenses before you make a decision on a policy through the new marketplaces. How you fare depends largely on 1) whether you qualify for a subsidy and 2) the type of health care you consume.
Those who need a lot of prescriptions, doctor's visits, tests and maternity or hospital care will fare well. But those who are mostly going to health clubs, occasional doctor visits and need eye and dental care (unless they buy the optional coverage), won't do as well with the government plans.
It would be helpful if the government had some quick and easy online calculator to help you with this tricky math. Maybe that's the next step to make the system more consumer-friendly – after they completely vanquish the technical bugs.
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