Obamacare: What will my plan cost? What doctors are covered?

Our first batch of reader questions about the federal health care reform law addresses how much individuals would pay to buy coverage, dental insurance, which health care providers are covered, and health savings accounts.

If you have a question about Obamacare, email health reporter Arielle Levin Becker at alevinbecker@ctmirror.org.

What’s my premium?

I'm 26, single, live in Fairfield County and make $17,000 a year. What will my premium be?

You'd pay about $55 a month if you buy insurance through Access Health CT, the state's new insurance marketplace, because your income qualifies you for financial assistance with your premiums and other out-of-pocket costs.

Here's how that's determined: If you earn under 400 percent of the poverty level, the federal health law says that you won't have to pay more than a certain percentage of your income to buy a particular health plan. In your case, your costs would be capped at 3.88 percent of income. That's about $55 per month.

The federal government will pay the insurance company for the rest of the cost of your premium.

(You can figure out the exact percentage of your income that you’d be required to pay by using this calculator. If you earn over a certain amount, there won’t be a limit, so you’ll have to pay the full price of insurance.)

That doesn't mean any plan you choose will cost you $55, though.

Here's where it gets complicated: The amount the feds will chip in for your coverage is a fixed dollar value, based on the cost of the second-cheapest silver plan sold by Access Health. For you, that plan would cost $337. Since your max cost for that plan is $55, the feds will pay the other $282. But if you want to buy another plan that costs more, the federal government will still kick in $282; you'll pay the rest. If you want a cheaper plan, the feds will still pay $282, and you'll pay less than $55.

So what are your options? Everybody buying coverage through Access Health can pick between three levels of plans: gold, silver and bronze. The gold plans have the highest premiums but leave you with less out-of-pocket costs when you get care. The bronze plans cost the least but have higher deductibles and coinsurance -- that is, costs when you get care.

You can find the exact costs of standard gold, silver and bronze plans on these charts. Find your age and county and the corresponding monthly premium.

In your case, though, there's another option: Because you earn below 250 percent of the poverty level, you're eligible for financial assistance with your out-of-pocket costs. You're eligible for a silver plan that has no deductible and lower copays than the other plans (the federal government is subsidizing it). That plan would cost you the least when you get medical care.

Because you're under 30, you could also buy a catastrophic plan. These have the lowest premiums (between $178 and $222 in your case), but the federal government won't pay anything to discount your premiums for these plans. They have deductibles of $6,350, so you'd have to spend that much before the plan pays for care (with the exception of 3 primary care visits and certain preventive services).

You can also buy coverage outside Access Health, through the state's existing individual market, but if you do, you won't qualify for a discount. That's only available if you go through Access Health.

 

Dental coverage

Do the health plans sold through Access Health CT include dental coverage?

According to the Connecticut Insurance Department, Access Health won’t be selling dental coverage for adults. Instead, it will link to standalone dental insurance plans sold through the state’s individual market. The insurance department is still reviewing the rates for those plans, so the costs have not yet been finalized.

 

Which doctors are covered?

There seems to be plenty of information about the cost of insurance through Access Health CT. But when and where is the access to participating doctors? As far as I can see, my costs are all set up, no choices except silver, bronze, etc., then the insurance provider. How to choose, unless lists of providers of care are listed? When and where will this information be available?

That’s not available just yet, but should by in October, when Access Health opens for people to begin buying insurance.

Chad Brooker, chief exchange policy and legal analyst for Access Health, said the insurance carriers offering coverage are treating their lists of participating health care providers as proprietary and are not sharing them with the Access Health staff. But he said that information should be available to people shopping for coverage Oct. 1.

Access Health is requiring that the networks of health care providers covered by insurers offering plans through its market maintain networks that are “substantially equal” to their existing networks. Because coverage does not take effect until Jan. 1, Brooker said Access Health staff will have time to examine the carriers’ networks and determine whether they meet the appropriate standards.

 

Health savings accounts

Do we know if a person signs up under the exchange (Access Health CT) for a high deductible plan, will that person be able to make contributions to an HSA account? Or does signing up for the exchange automatically disqualify that person from contributing to an HSA? The latest IRS Instructions for Form 8889 do not yet address this issue.

According to the Congressional Research Service, people can contribute to health savings accounts if they are enrolled in health plans that meet two criteria. First, the plan must have a deductible above a certain minimum level. In 2014, that level requires an annual deductible of at least $1,250 for individual coverage or $2,500 for family coverage. The second requirement is that members’ out-of-pocket costs can’t exceed $6,350 for an individual or $12,700 for family coverage.

The health reform law doesn’t prohibit insurers from offering high-deductible plans with health savings accounts, as long as they meet the requirements listed above.

This answer has been updated. A previous version of this response contained information provided by sources that was inaccurate.

 

What’s my premium, part 2

What would it cost to buy insurance for a 43-year-old male, $40,000 income, living in Fairfield County. He’s married with no kids under 19, but only he needs insurance.

He would qualify for about $170 off the monthly price of any plan he picks if he buys insurance through Access Health CT. Factoring in that discount, his monthly premium costs would range from $154 to $347, depending on what type of plan he chooses.

A word about the different plan types: People buying insurance through Access Health will get a choice between three types of coverage, bronze, silver and gold. Bronze plans have the highest out-of-pocket costs (a $3,250 deductible for an individual, and once that’s met, the members would still have to pay 40 percent of the cost of care for many services). The silver plans cost more, but require paying less when getting care (there’s still a $3,000 deductible but many services don’t apply to the deductible). The gold plans have the lowest out-of-pocket costs, including a lower deductible, but have the highest premiums.

Based on this man’s age, county and income, his monthly premium prices, after applying the discount, would be as follows for standard plans offered through Access Health:

Bronze: $154 to $196

Silver: $236 to $293

Gold: $296 to $347

Men and woman will be charged the same rates for insurance as of 2014 under the federal health law.

 

For more information on what insurance will cost through Access Health CT, click here.

To learn more about how Obamacare will affect you, click here and here.

 

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