ACA Federal Marketplace updates

[Htown Harry]

Here's a first hint about rates in Texas, Florida and some other states;
Average Obamacare Premiums Will Be Lower Than Projected - Kaiser Health News

The analysis showed huge variations among states: A family of four making $50,000 in Wyoming, for instance, would pay $1,237 a month on average for a midlevel plan before subsidies, compared to $584 a month on average in Tennessee. After subsidies are added in, however, the cost to both families would be $282 because the amount they pay is linked to their income, not to the cost of coverage...

While experts say premiums vary across the states and even within states, the analysis pegged the national average for an individual at $328 a month for a midlevel policy called a silver plan, before subsidies are factored in. That’s less than the average $392 projection drawn from earlier data released by the nonpartisan Congressional Budget Office, which will mean savings to families as well as to the federal government for tax credits...

One of the report’s most striking findings is that states like Texas and Florida, where the law has faced fierce opposition despite high rates of uninsured residents, will see rates at or below the national average.

Here's a link to the full report:
ASPE

Unfortunately, the comparative data focuses on 27-year-olds and families of four, two demographics not well represented here at ER.org.

There is a table, on page 15, that lists second-lowest silver plan premiums by state (calculated as a weighted average). My only firm conclusion reviewing the information was that Wyoming is likely to move down many "best places to retire early" lists.

Also available are charts showing the number of plans available in the states' individual "rating areas". ASPE

In Houston, I see that there will be 50 plans offered by 7 carriers: 4 catastrophic plans, 14 bronze, 17 silver, 14 gold and 1 platinum.

 

[MichaelB]

We just got our non-renewal letter in Fl. According to this preliminary info, we'll have 136 plan choices. I wasn't concerned before this and find myself becoming slightly optimistic.

 

[2B]

In Houston, I see that there will be 50 plans offered by 7 carriers: 4 catastrophic plans, 14 bronze, 17 silver, 14 gold and 1 platinum.

I'm waiting on the details. It's not clear to me what area Houston is in and are the prices per person or per family. Then, there is the need to check the doctors and hospitals on the plan.

My benchmark based on my personal situation is the Texas High Risk Pool. DW and I would have had to buy individual policies each costing $7,500/yr with a $7,500 deductible. There are no subsidies for these. My COBRA is $830/month but it only runs for 18 months before I would have been forced into the high risk pool.

With health care easily being my largest single budget item in retirement, the ACA will end up reducing my "essential" retirement cost. The subidy will save me even more. Unfortunately, I won't qualify the first year for the subsidy with my SERP payout.

 

[Htown Harry]

It's not clear to me what area Houston is in and are the prices per person or per family.

It takes a bit of page-clicking to determine your rating area.

At the second page I linked, follow a link at "For further information about rating areas, please see:" to view rating area designations by your home county. Then you can go back to the table showing the number of plans available by rating area and see which line applies to you.

I agree the actual prices and plan details are the required information for actual decision-making. Like Michael, however, I feel this first peek through the gate is anything but alarming or surprising.

 

[ERhoosier]

We just got our non-renewal letter in Fl. According to this preliminary info, we'll have 136 plan choices. I wasn't concerned before this and find myself becoming slightly optimistic.

OTOH-----Unfortunately, reading this report has confirmed my worst fears. I'm in one of the highest cost MSA's, and earlier predictions of some massive rate increases turned out to be spot on. After applying ACA's 2.5-3X rate multiplier (my age/nonsmoker vs report's 27yo example), it appears we will see a rather painful rate INcrease once my COBRA runs out. If my math is right, for DW & I (no kids/nonsmokers) it means >50% premium jump PLUS a major rise in our OOP max (from $5k to $12+k).

 

[2B]

I agree the actual prices and plan details are the required information for actual decision-making. Like Michael, however, I feel this first peek through the gate is anything but alarming or surprising.

I agree that this isn't alarming or surprising. It sounds like we'll get what seemed to be obvious which is the younger people will pay more than now and older people will pay less. The silver plan covers about what the Texas High Risk Pool would and is slightly cheaper (zone 10) if I assume the rates shown are per person. Other than the possible subsidy, this hasn't changed much for me. I'll know more when the details are out.

I think it's interesting that the federal exchange (done for the states that didn't throw billions of their own dollars to create their own exchange) looks to be in pretty good shape. I figured this would happen. Unfortunately, all states didn't do this. The federal exchange will make it easier to allow insurance to be eventually sold across state lines. I never could figure out why any state wanted to do their own. Why reinvent the wheel when it would just be given to you?

 

[2B]

OTOH-----Unfortunately, reading this report has confirmed my worst fears. I'm in one of the highest cost MSA's, and earlier predictions of some massive rate increases turned out to be spot on. After applying ACA's 2.5-3X rate multiplier (my age/nonsmoker vs report's 27yo example), it appears we will see a rather painful rate INcrease once my COBRA runs out. If my math is right, for DW & I (no kids/nonsmokers) it means >50% premium jump PLUS a major rise in our OOP max (from $5k to $12+k).

You can put different ages into the form and see what the policies are for that age. I'm just not sure if that is for a family or just an individual. The reason the cost will just up over COBRA is that the rate you are paying is the company average. With the ACA, you get the price for your age which is higher if you are over 40 or 45. A younger person would save money by getting off COBRA ASAP.

My COBRA is $830/month for the family plan. With the ACA, my deductible and premium will increase but my copay will stay about the same with the silver plan.

When the real details are available, lots of research will be needed to figure this out. Also, will off-network plans suddenly appear?

 

[fisherman]

The updated Kaiser calculator is a big improvement. It calculated within $2 from the average for my area reported.

I also ran the numbers against what I pay now for a bar bones 100% out of pocket for the first $10,400 policy I have now and compared to a bronze plan which is an improvement I would see a 6% increase next year. That would be the lowest increase I have seen since buying my first individual policy in 2006. The calculations are all made at full freight cost without subsidy.

The above comparison is also not apples to apples as the new policy provide better coverage than the current bare bones policy.

I am not surprised at this but I am happy about it.

 

[rbmrtn]

OTOH-----Unfortunately, reading this report has confirmed my worst fears. I'm in one of the highest cost MSA's, and earlier predictions of some massive rate increases turned out to be spot on. (

I guess there many sides to the coin. I am in the 3rd highest cost exchange but I am glad to be able to purchase HI. Most individuals are rejected here regardless of health. Strange thing, even though the exchange numbers are high, compared to what I know some folks in small groups are paying, it's about 25% - 50% less than what they are currently paying and the insurance is better. It's 20% less than what COBRA was a few years ago. This before applying subsidies. It will be interesting to find out more about why the rates are what they are.

 

[Texas Proud]

One of the things that I would want to know is the discount rate that these plans provide to the insured...

IOW, my DW had a knee operation.... the hospital charges were $16K.. the insurance rate was about $3.5K... a cheap plan that does not get that kind of discount is a pretty bad plan IMO.... I do not know if another insurer would have been higher or lower.... but I doubt that all would be the same price....


Now, I did get a nasty surprise.... we have a $5K deductible plan with a $7.5 MOOP... I thought that the first $5K went toward that max.... NOT.... so when I thought that my max would be $7.5, it really if $12.5....

 

[W2R]

Thank you!

The following link was also provided above, but bears repeating since it is extremely helpful. It gives me some idea of what a 60-year-old in Louisiana might be paying for various plans:

http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/datasheet_home.cfm

 

[MRG]

I'm just glad to get more information. Think I have a better idea of my costs, think I'll save couple hundred a month.

MRG

 

[MRG]

I
I think it's interesting that the federal exchange (done for the states that didn't throw billions of their own dollars to create their own exchange) looks to be in pretty good shape. I figured this would happen. Unfortunately, all states didn't do this. The federal exchange will make it easier to allow insurance to be eventually sold across state lines. I never could figure out why any state wanted to do their own. Why reinvent the wheel when it would just be given to you?

Yes, I don't understand that either. I've just used Mediacare.gov (for DW) for first time. Really don't understand why that site wasn't just enhanced for the federal exchange. Seems pretty decent, not sure I've found integration between the plans and providers yet. That may be my ignorance.

MRG

 

[ERhoosier]

..... The reason the cost will just up over COBRA is that the rate you are paying is the company average. With the ACA, you get the price for your age which is higher if you are over 40 or 45. A younger person would save money by getting off COBRA ASAP.

Agree COBRA cost is company ave, but COBRA is NOT always cheaper for comparable coverage (inc OOP max) than indiv market even at some arbitrary older age. HI premiums for employers (inc COBRA) depend largely on the specific population mix for specific employer, inc ave age, prevalences of diseases & smoking, usage pattern (e.g. ave freq of provider/hosp visits, expensive testing, etc), etc. Specific COBRA policy may include coverage individuals may not want or need (e.g. maternity, lower deductibles, etc.). And there are still a few employers who simply pick grossly overpriced HI for their market (i.e. poor negotiating skills with the carrier). FWIW- HR folks at my prev employer openly encouraged exiting workers, inc ER's, to shop around for HI before going COBRA. More than a few folks find COBRA is not their best option for HI.

In my case I was comparing a pre-ACA individual policy meeting my needs (HSA-qualifying plan) offered to self-employed (which I still am) for my state of health & completely healthy DW. It is (was?) being offered by an established major carrier which has apparently chosen NOT to offer coverage under the Exchange in my state.
From published info- Under ACA DW & I would/will be paying $14+k/yr for HI premiums (2nd lowest Silver, no subsidy) PLUS facing much higher OOP max of $12,700/yr. So annual HC costs could be >$27,000 per year. Might be better off going uninsured (self-insured) and paying the uninsured tax (official SCOTUS term for it)- or letting IRS try to collect it from my non-existent income tax refund. I could literally pay OOP for ave cost coronary bypass surgery about every 2 yrs and still break even under ACA !!!
Coronary Bypass Surgery Pricing by Healthcare Blue Book

As always YMMV, but my state's high-risk pool (pre-ACA) would have been a MUCH better deal than what ACA has turned out to be.

 

[Htown Harry]

I found a couple of oddities looking at the data.

The first is the minimal number of platinum and catastrophic offerings. Platinum plans aren't even offered in many areas. The number of catastrophic plan offerings is also small: only 2 or 3 for a typical area in my state.

The second is the unexpected relationship between minimum cost catastrophic plans and minimum cost bronze plans as seen in the detailed Excel tables. Using Texas MSA's and my age (53) as a test, the cost of a min. cost catastrophic plan ranges from 20+% less than a bronze plan to 20+% more than a bronze plan.

Taken together, I guess this shows there are weird pricing effects at the margins, where the insurers see the greatest risk of adverse selection and other "fat tail" risks?

 

[meierlde]

Taking the Texas average rate in the Dallas area, of 230 or so and mulitplying by 3 gets one about $700 a month. Now looking at the existing high risk pool (which does vary its rates by where one lives in Tx), Dallas along with Houston is in the highest cost area, so that is area 6 on the pool's tables. With a 2500 deductable the cost for 60-64 is 1164 (averaged men and womens rate) or with a 5000 deductable at 924. Stepping to the 55 to 59 age range its 998 for a 2500 deductable and 793 for a 5000 deductable. Note that the plan has a $3000 in network co insurance limit and a $10k out of network co-insurance limit. As a result the 2500 deductable is likely a bit closer with a 5.5k max out of pocket to the 5000 with an 8k out of pocket max.
Of course the pool is going out of business on Jan 1, 2014

 

[ERhoosier]

After downloading the Marketplace .xls SS for premiums, agree with Harry that there are some curious pricing issues. Could these be to differences in level of coverage (beyond ACA minimums) between Bronze plans? From what I understand, catastrophic plans for >30yo crowd are restricted to limited circumstances in mainly low income folks (e.g. homeless, QHP would otherwise be >8% MAGI, etc.). Not sure why these folks would opt for catastrophic plan since these are not eligible for subsidy and usu cost almost as much as Bronze.

 

[Mulligan]

Agree COBRA cost is company ave, but COBRA is NOT always cheaper for comparable coverage (inc OOP max) than indiv market even at some arbitrary older age. HI premiums for employers (inc COBRA) depend largely on the specific population mix for specific employer, inc ave age, prevalences of diseases & smoking, usage pattern (e.g. ave freq of provider/hosp visits, expensive testing, etc), etc. Specific COBRA policy may include coverage individuals may not want or need (e.g. maternity, lower deductibles, etc.). And there are still a few employers who simply pick grossly overpriced HI for their market (i.e. poor negotiating skills with the carrier). FWIW- HR folks at my prev employer openly encouraged exiting workers, inc ER's, to shop around for HI before going COBRA. More than a few folks find COBRA is not their best option for HI.

In my case I was comparing a pre-ACA individual policy meeting my needs (HSA-qualifying plan) offered to self-employed (which I still am) for my state of health & completely healthy DW. It is (was?) being offered by an established major carrier which has apparently chosen NOT to offer coverage under the Exchange in my state.
From published info- Under ACA DW & I would/will be paying $14+k/yr for HI premiums (2nd lowest Silver, no subsidy) PLUS facing much higher OOP max of $12,700/yr. So annual HC costs could be >$27,000 per year. Might be better off going uninsured (self-insured) and paying the uninsured tax (official SCOTUS term for it)- or letting IRS try to collect it from my non-existent income tax refund. I could literally pay OOP for ave cost coronary bypass surgery about every 2 yrs and still break even under ACA !!!
Coronary Bypass Surgery Pricing by Healthcare Blue Book

As always YMMV, but my state's high-risk pool (pre-ACA) would have been a MUCH better deal than what ACA has turned out to be.

I don't blame you for thinking this ER. I am going to get burned percentage wise in a bad way too, triple digits plus. But at a lower price point. If it got to where I thought enough was enough, I wouldn't pay the tax, come and get it if you think you can. And right now the means to collect is very thin, as I would make darn sure no refund was coming my way. Of course there are probably millions of twenty something "invincibles" thinking the same thing. As long as I stay healthy and can collect an HSA deduction, I won't complain too much.

 

[explanade]

Where is this Excel spreadsheet?

 

[Htown Harry]

Where is this Excel spreadsheet?

Here: http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/Marketplace_premium_databook_2014.xlsx

Notes about this File:

1) This analysis uses data pulled on 9/17/2013 at 1:00 AM. It excludes plans that are "Off-Exchange Only" and/or "Child-Only." It also excludes plans that were withdrawn or denied certification.
2) There are 36 states contained in this file. These states are either FFM, SPM, or SSBM states. Each of these 36 states has its own tab and the tabs are sorted alphabetically by state abbreviation.
3) The default age used to calculate ratings is 21. This default can be changed by selecting the drop down in cell H2 of each state tab. All the relevant rate information will update based on the selected age.
4) Each state tab has one row for every rating area in that state. The number of rating areas varies by state.
5) To look up the rating area for a corresponding zip code, navigate to the "Zip Code-Rating Area Lookup" tab.

 

[2B]

As always YMMV, but my state's high-risk pool (pre-ACA) would have been a MUCH better deal than what ACA has turned out to be.

I find that surprising but I probably shouldn't be. Insurance (all types) are shrouded in a cloak of mystery and the rates are determined by means that mediveal alchemists would find arcane.

Insurance is something for people that can not withstand the risk of the event it covers. Insurance companies build those wonderful buildings, hire lots of well paid people and spread dividends to their shareholders by charging the average person more than their share of the pooled risk.

Some people are in a postion to fully self-insure for their medical care. I'll use as an example Mitt Romney. He gets medicare now (if he bothers to use it) but why would our government feel compelled to force a centi-millionaire (if not higher) to buy HI. However, our ACA does just that.

For your case (and mine), paying for $50,000 in occasional episodes of medical treatment would probably be cost effective over paying for $27,000 in annual insurance costs. I'm estimating my actual insurance cost at less than $15,000/yr with the OOP simply what I would have paid anyway. Even at that lower rate, either DW or I would still need to undergo very high dollar cancer treatments to make the HI cost effective. Normal things (like bypass surgeries?) would not trip the wire to make them cost effective.

The same sort of argument gets used on LTC insurance. At a certain point there is no need to enrich an insurance company. The only insurance I think I really need at this point is liability insurance which forces the purchase of an umbrella over my home owners and auto insurance.

 

[2B]

Taking the Texas average rate in the Dallas area, of 230 or so and mulitplying by 3 gets one about $700 a month. Now looking at the existing high risk pool (which does vary its rates by where one lives in Tx), Dallas along with Houston is in the highest cost area, so that is area 6 on the pool's tables. With a 2500 deductable the cost for 60-64 is 1164 (averaged men and womens rate) or with a 5000 deductable at 924. Stepping to the 55 to 59 age range its 998 for a 2500 deductable and 793 for a 5000 deductable. Note that the plan has a $3000 in network co insurance limit and a $10k out of network co-insurance limit. As a result the 2500 deductable is likely a bit closer with a 5.5k max out of pocket to the 5000 with an 8k out of pocket max.
Of course the pool is going out of business on Jan 1, 2014

You can adjust the spread sheet for the ACA to your actual age. Multiplying by 3 is not needed.

 

[2B]

After downloading the Marketplace .xls SS for premiums, agree with Harry that there are some curious pricing issues. Could these be to differences in level of coverage (beyond ACA minimums) between Bronze plans? From what I understand, catastrophic plans for >30yo crowd are restricted to limited circumstances in mainly low income folks (e.g. homeless, QHP would otherwise be >8% MAGI, etc.). Not sure why these folks would opt for catastrophic plan since these are not eligible for subsidy and usu cost almost as much as Bronze.

All we have available on the federal exchange is very limited information. We really won't be able to compare choices until they are all listed side-by-side. Summaries and "lowest" don't mean much with out the ability to look at their networks of hospitals and doctors. Without much trouble I could be the lowest cost insurance provider by offering a plan to Houston residents where their only doctor and hospital available are in Amarillo. Cynical me does not doubt there will be some plans that play off limited availability of care providers to achieve a lower "headline" cost.

 

[MichaelB]

Without additional detail I don't think we can draw any meaningful any conclusions from the excel data.

 

[MichaelB]

Updating an earlier post, it seems the DC exchange will stumble out of the starting blocks. Computer snags delay parts of Obamacare in some U.S. states - baltimoresun.com

The "DC Health Link" web-based marketplace, where residents of the nation's capital who do not have other coverage will be able to purchase policies, will lack the ability to calculate whether someone is eligible for Medicaid. It will also be unable to calculate the size of federal subsidies, if any, that a customer qualifies for.