Obamacare Q&A: Health insurance costs and options for 2015
Looking to buy health care coverage for next year?
Compared to this year, premiums for health plans sold through the state’s individual market are, on average, decreasing or rising slightly. But the exact change will depend on the type of plan you buy. While some customers will see big drops in price, others could face significant increases. And many won’t pay “sticker price” at all, because their rates are discounted by the federal government.
For people buying plans through the state’s health insurance exchange, Access Health CT, there will also be some changes in the way plans are structured. Here’s a look at what you need to know about the prices and plan options.
How are insurance prices changing in 2015?
Here are a few examples, based on the prices for standard plans sold through Access Health. Each insurer selling plans through the exchange must offer plans that follow a standard design. The plans have the same benefits package, but each carrier’s version will differ in price, the health care providers who accept it, and the way prescription drugs are covered. Insurers can also sell additional plans with unique designs.
|Anthem Blue Cross and Blue Shield||$261.28||$240.75||↓|
|Anthem Blue Cross and Blue Shield||$342.27||$348.82||↑|
|Anthem Blue Cross and Blue Shield||$430.25||$439.71||↑|
|Anthem Blue Cross and Blue Shield||$664.45||$679.06||↑|
Something to note: Even if an insurer’s rates stay the same from year to year, the rates for a particular customer would go up because the person is a year older, and increased age means increased rates.
What are those prices based on?
Each person’s premium cost is based on four factors: Age, county, the specific plan and the insurance company offering it.
The calculations start with something known as a “base rate.” Each insurance company has a different one, ranging from $195 to $380. That figure gets multiplied by three different numbers, corresponding to the person’s age, county and plan choice.
Age is the biggest variable: A person who is 64 will pay three times as much as a 21-year-old.
Location also matters. In general, people in Fairfield County pay the most for insurance, but the extent to which a county raises or lowers a person’s premiums varies by insurance company.
The other factor is the type of plan a person picks. Bronze plans have the lowest premiums, but require members to pay the largest share of their medical costs. Gold plans, by contrast, have the highest monthly premiums, but cover a larger share of members’ medical expenses. Silver plans are in the middle.
In 2015, ConnectiCare Benefits is offering a platinum plan, which will have the highest premiums but will cover close to 90 percent of a member’s medical expenses, more than any other plan available to all customers through the exchange.
What about people with subsidies?
The majority of people who bought insurance through the exchange this year don’t pay the plans’ “sticker price.” That’s because they receive discounts on their premiums, subsidized by the federal government.
The subsidies aren’t going away, so people whose income is low enough will still qualify for discounted premiums. (The income limit for getting a subsidy next year will be about $46,680 for a single person and $95,400 for a family of four.)
Here’s how subsidies work: They’re set so people who qualify won’t have to pay more than a certain percentage of their income on insurance premiums for a midlevel plan. (The exact percentage varies based on income, from 2.01 percent to 9.56 percent.) People can use the dollar amount of that discount to purchase any exchange plan.
What will those prices get you?
In general, the less you pay in premiums, the more you’ll have to pay when you get medical care.
The template for each standard plan is below. To read the notes, click on the yellow tab or area. (To see how the 2015 standard plans differ from those being sold in 2014, click here.)
Some key things to note:
Most plans have a deductible, meaning that members have to pay a certain amount of money for their care before the insurance company begins chipping in. It’s important to pay attention to what services are subject to the deductible. In some plans, the deductible only applies for certain services, like hospitalization, and the insurance company will pay for other services from the start. In other plans, people will have to pay out of pocket for nearly all services until they fulfill the deductible.
Another number to pay attention to: the out-of-pocket maximum. That’s the maximum amount members have to pay for medical care under the plan. Premiums don’t count toward that figure.
Finally, it’s important to know the difference between a copay and co-insurance. A copay is a fixed dollar amount, like $30, that you pay when you get medical care. It doesn’t change regardless of how much the service costs. Co-insurance means you have to pay a certain percentage of the cost of care, like 10 percent or 40 percent.
Standard bronze HSA (health savings account)
Deductible: $4,600 for an individual, $9,200 for a family (for in-network services)
Out-of-pocket maximum: $6,450 for an individual, $12,900 for a family (for in-network services)
Nearly all services are subject to the deductible.[documentcloud url=”https://www.documentcloud.org/documents/1279079-access-health-ct-2015-bronze-hsa-standard-plan.html”]
Deductible: $5,000 for an individual, $10,000 for a family (for in-network services)
Out-of-pocket maximum: $6,600 for an individual, $13,200 for a family
Nearly all services are subject to the deductible, but people can receive up to three mental health and three medical visits before the deductible applies.[documentcloud url=”https://www.documentcloud.org/documents/1279075-access-health-ct-2015-bronze-standard-plan.html”]
Deductible: $2,600 for an individual, $5,200 for a family (for in-network services).
There is a separate deductible for prescription drugs: $25 for an individual, $50 for a family (for in-network)
Out-of-pocket maximum: $6,600 for an individual, $13,200 for a family
Most medical services are not subject to the deductible. Instead, members have copays in most cases. Hospital services are subject to the deductible.[documentcloud url=”https://www.documentcloud.org/documents/1279076-access-health-ct-2015-silver-standard-plan.html”]
Deductible: $1,000 for an individual, $2,000 for a family (for in-network services)
Out-of-pocket maximum: $3,000 for an individual, $6,000 for a family
Most medical services are not subject to the deductible. Instead, members have copays in most cases. Hospital services are subject to the deductible.[documentcloud url=”https://www.documentcloud.org/documents/1279077-access-health-ct-2015-gold-standard-plan.html”]
Deductible: This plan has no deductible for in-network services
Out-of-pocket maximum: $2,000 for an individual, $4,000 for a family
ConnectiCare Benefits is the only insurance company offering a standard platinum plan in 2015.[documentcloud url=”https://www.documentcloud.org/documents/1279078-access-health-ct-2015-platinum-standard-plan.html”]