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I am happy to report from my little corner of St Louis suburbia that another good friend enrolled for insurance via the federal health exchange on 1/1/14!  She had been recently laid off from her job and in 30 days is losing her ex-employer provided health insurance.  She is eligible for unemployment which puts her at approximately $13,000/year, and because Missouri did not take the Medicaid expansion, she decided to see if she was eligible for insurance via the ACA.  She is eligible and so she was able to find a Silver Plan with Coventry Insurance with no deductible and $0 monthly premium!  She is very happy; couldn't believe it was really possible.  Now, what is really sweet for me about this is that she is a staunch Republican and hates Obama!!  Of course, I would NEVER demand that she now take back all her past Obama-bashing! : )

Today she filed an ACA application for her boyfriend on the federal exchange.  His employer supplied insurance premium has gone up to $370/month and his monthly income is $2200.  She found that he was also eligible for insurance through the ACA with tax subsidy help.

Missouri only has (2) insurance companies on the exchange, I do not know why only two, but they are BCBS and Coventry.  I helped her during her process of picking a plan and she had (7) silver plans and (5) gold plans to choose from. (Missouri does not offer a platinum plan, I have no idea why not).  We both found it difficult to really compare the different plans, i.e., some of the gold plans had higher deductibles and premiums, but we couldn't find anywhere on the website that explained what extra benefits one would receive if you were willing to pay a little extra for it.  Also, when we clicked on the link for "specific details" of the plan we were interested in, we would be transferred to the insurance company's website which would take us to a table containing the specific plan's information, however, the prices did not correlate with the prices quoted on the federal website for the very same plan (insurance company website's prices had very high deductibles and premiums).  We assumed that the insurance company's website prices were probably for someone just coming in off the street looking for insurance and did not have the tax subsidy figured in, but it was very confusing to say the least and made us wonder why the plan details on the federal exchange linked to the insurance company's website in the first place knowing the prices could possibly not correlate for folks eligible for tax subsidies?

Although my friend easily decided to select the silver plan with $0 deductible and $0 premium, and maximum out of pocket expenses of $1500, it gets a lot more difficult to choose a plan when you only receive a "partial" subsidy, like for her boyfriend, and it is very difficult to compare plans with specific details.  I realize there is a tool on the federal exchange for comparing plans, but it is very high level and does not compare the fine details of the plans.
I also realize that details on insurance and what they cover/do not cover is really hard to find out until of course you turn in your first bills.

The other part that we found difficult to understand is how the subsidies are applied; are they only applied to the monthly premium?  What about the deductible amounts shown for the different available plans?  And, when you start comparing plans and looking and comparing deductibles, the information provided about the deductibles is not real clear, i.e.,  with what services do you have to meet the deductible first before receiving any benefit?  Some of the plans are labeled as PPO $5 co-pay, and that used to mean you did not have to reach your deductible for doctor office visits, you would only be responsible for the co-pay of $5 for the visit.  Now, when you try and compare the plans and are forwarded to the insurance company's website, you are hit with statements like "no services are covered until deductible met".  So does this apply to preventive care exams and tests?  It certainly sounds as if there is no benefit until the insured person reaches the deductible, but this contradicts the PPO Co-pay understanding and the $0 cost for preventive care ushered in by the ACA law.

Has anybody run into this and have any suggestions for how would be the best way to really compare the plan details in order to make an informed decision?


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Comment Preferences

  •  For her, Silver plans have copay subsidies (7+ / 0-)

    People with low incomes not only get premium subsidies, but they also get subsidies for the copays/co-insurance/deductible, provided they buy Silver plans.

    The insurance company shows the deductible for the plan, which might be something like $5000, but since she has out-of-pocket subsidies, she doesn't have to pay all of the deductible herself. Her deductible might be something like $1000, and the government pays the rest. Same for her copays and co-insurance. That's why the insurance company website shows a different number than the federal website. She should believe the numbers on the federal website.

    •  Yep. Exactly this. (0+ / 0-)

      Silver plans receive special cost-sharing subsidies on top of premium assistance. This means that for people receiving subsidies the actuarial value of silver plans are more than the defined 80/20 ratio. For people receiving the most subsidies, it can be a better deal than getting platinum insurance - maxing out at 94/6 ratio.

      See this (PDF) report by Kaiser explaining the cost-sharing subsidies. Also see this (PDF)report than by the ACS.

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