The big lie that the Kochs and others are telling young adults is that the age rating rules in the ACA will lead to subsidies from the young to the somewhat older. That sounds unfair, given that middle-aged folks are presumed more likely to be prosperous. But setting that aside, what's the reality of it?
In a diary I posted yesterday, I compared Romneycare rates with Obamacare rates for middle-aged folks like me. Turns out that the prices don't change much. Obamacare plans are less generous, with higher out of pocket costs, but cost less; an Obamacare Gold plan is more like a Romneycare Bronze plan with a similar price and coverage.
But what about young'ns who are supposedly cheaper to cover?
The old Romneycare exchange and the new Massachusetts Health Connector v2 Obamacare exchange are both running now. The former only provides coverage through the rest of the year, after which the new one takes effect. But it's a chance to compare.
So I inquired about a mythical single 25-year-old in my ZIP code. They are able to get special Romneycare young adult plans. I compared three "young adult plan" providers.
This "YAP Low" level has a $2000 deductible, $5000 out of pocket cap, $25 office visit copay, $250 emergency room copay, and 20% hospital copay after deductible.
With no prescription coverage:
NHP $185.69 (lowest)
Tufts: 275.99 (highest)
HPHC: 201.34 (lowest with wide coverage, full network)
Neighborhood Health Plan is a small Boston-only operation with a relatively small network, but it's useful if you're in town and willing to accept their providers. It's available in my ZIP code but really doesn't cover much here; you'd usually have to go into Boston for service. The Tufts and Harvard Pilgrim plans are full-service HMOs that have almost all providers included. The HPHC plan looks like the best deal under Romneycare if you feel invincible.
Add prescription coverage ($15 for generics) and it goes up a bit:
NHP: 213.29
Tufts: 305.87
HPHC: 237.05
Not a lot for coverage, if you've priced out prescription drugs lately. Having insurance lowers the price that the pharmacies charge you.
The "YAP High" plan has only a $250 deductible, a $5000 cap, $25 Office Visit, $15 Generic Rx, $250 ER, but note a high 30% hospitalization co-insurance.
NHP: 227.11
Tufts: 389.99
HPHC: 322.85
Same order of price. But move to a more grown-up plan and the ranking changes:
Silver Low: $1000/2000, $20 office / 15 Rx / 100 ER / no hosp. co-insurance.
NHP: 330.92 (lowest)
Tufts: 422.08 (best full network plan rate)
HPHC: 463. 24 (higher priced at this level)
Obamacare is supposed to narrow the age-rating and screw the young, right? Well, maybe not. Start at the bronze level (we have no "catastrophic" level here but bronze is close enough) $2000 deductible, $6350 cap, $50 office visit, $30 generic Rx, $1000 hospitalization deductible. Worse than the old YAP Low plan except that if you spend more than a day or so in the hospital, the old 20% co-insurance will cost more than $1000. Same providers (and there are a lot more here in Boston):
NHP: 206.30
Tufts: 283.51
HPHC: 293.24
BMCHN: 167.83 (lowest)
Hmmm, NHP is cheaper than the former with-prescription rate. Tufts comes down, but Harvard Pilgrim (our HMOs are often named after medical schools) goes way up. So it's a mild lose, though the cheapest Boston-centric (small local network) option, Boston Medical Center HealthNet, is cheaper than any Romneycare plan.
Obamacare Silver is usually almost the same but with $30 office visits and $20 prescriptions:
Tufts: 300.11
HPHC: 329.49 but adds 20% co-ins on hosp., not a fixed deductible.
NHP: 245.87
Gold lowers the deductible to $1000, still a $5000 cap, with $30 office visits, $20 Rx, and $500 hospitalization. This is a bit worse than Romneycare Silver Low.
Tufts 423.49
NHP: 284.37
BCBS HMO Blue: 418.68 ($1500/4000, 25 / 15 / 250)
Hmmm, Neighborhood Health Plan is cheaper than before (was silver low), Tufts about the same, and Blue Cross HMO Blue comes in with a comparable plan (higher deductible, cheaper everything else) that beats some of the competition.
So while the plans differ and if you're on Romneycare you'll want to re-evaluate your options, the overall rate levels of the old and new plans for 25-year-olds are very close. This implies to me that the local HMOs (these are all "nonprofit") are being pretty honest with their pricing (several had to make Obamacare rebates already due to low medical loss ratios), so the changes mostly reflect slightly different risks. There's no massive screwing of the young. They will still pay a LOT less than old phartz like me do!