Example Pricing: Western Pennsylvania
Explanation of Graphics
As you can see, each health insurance provider listed a plan for
each of the metal levels which we discussed in the previous blog post. You may also notice a “Catastrophic”
option. This is available to adults
under 30 years old. It is a very low
monthly payment compared to the metal levels, but a higher out-of-pocket
expense if the person needs something extra such as an emergency room
visit.
The Catastrophic plan allows for
3 primary care visits/ year with no added cost (compared to unlimited visits
with the metal level plans) and must cover the essential health benefits which
we covered in the Halloween post.
Plan Pricing is based on four factors:
Age:
Before the ACA, older people
were charged on average 5 times more for health insurance than younger
people. Under the ACA, seniors (age 64
or older) cannot be charged more than 3 times the rate of a younger person’s plan
(age 21-63).
Tobacco Use:
A smoker can be charged 50% more than a non-smoker. Why would you ever disclose whether you’re a
smoker then? You can potentially lie
about this to avoid the higher cost, but if your health claims start looking
like you are a smoker, you may have to deal with the ramifications. Many insurance companies had already begun
this extra penalty about 10-15 years ago.
If you don’t want to pay the extra cost and you aren’t brave enough
to lie, you do have another option. As
long as you are enrolled in a smoking cessation class (you don’t even have to
quit smoking), you should not have to pay a higher cost.
Family Size:
This depends on factors such as your combined household income (the
total of what each member of your family is expected to make in 2014), family
members’ ages, and their smoking habits.
Geographic Area: States are split up into different geographic
regions to create smaller, competitive markets so that prices can be reasonable
for each region instead of overpriced.
Pennsylvania is divided into 9 different regions.
Side Note: Plans that were created before March 2010 and remained unchanged in
the past few years are “grandfathered” into the ACA. These plans do not have to charge according
to these four factors. Plans created
after this date had to change to fit ACA criteria. President Obama has been catching heat
because of these “grandfathered” plans.
Subsidy
Most Americans should receive a tax subsidy with the purchase of
their plans. Any individual making less
than $45, 960 and any family making less than $94, 200 is supposed to get some
sort of compensation to help them pay for their plans. You can use the Kaiser Foundation’s Subsidy Calculator to get an estimate on what you might receive.
A Word of Caution: I am a little worried, though. Before the Marketplace opened and plan prices
were still unknown, I was able to get a subsidy estimate for a 25-year-old
non-smoker who made $30,000/ year. Now,
if I enter the same information, the subsidy comes up as $0. The calculator figures this based upon a
silver level plan.
I am hoping that there
is a subsidy for the bronze level plan or that the calculator is inaccurate. I am not sure how many more “lies” or problems with the ACA the American people will put up with.
If you are truly curious, I suggest you call 1-800-318-2596. I imagine
someone will be able to tell you what your subsidy would be.
