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| FILE - In this Dec. 3, 2013 file photo, actor Adrienne Matzen poses in Chicago's theater district. Matzen, 29, who has been mostly uninsured since she turned 21, is now looking for a low monthly premium insurance plan on the federal website. High deductibles for health plans available on the Illinois insurance exchange may contribute to sticker shock when people start paying medical bills in 2014, if they have elected to pay for insurance under the Affordable Care Act. |
CHICAGO (AP)
-- As a key enrollment deadline hits Monday, many people without health
insurance have been sizing up policies on the new government health care
marketplace and making what seems like a logical choice: They're
picking the cheapest one.
Increasingly,
experts in health insurance are becoming concerned that many of these
first-time buyers will be in for a shock when they get medical care next
year and discover they're on the hook for most of the initial cost.
The
prospect of sticker shock after Jan. 1, when those who sign up for
policies now can begin getting coverage, is seen as a looming problem
for a new national system that has been plagued by trouble since the new
marketplaces went online in the states in October.
For
those without insurance - about 15 percent of the population- "the
lesson is it's important to understand the total cost of ownership of a
plan," said Matt Eyles, a vice president of Avalere Health, a market
analysis firm. "You just don't want to look only at the premium."
Counselors
who have been helping people choose policies say many are focused only
on the upfront cost, not what the insurance companies agree to pay.
"I
am so deeply clueless about all of this," acknowledged one new buyer,
Adrienne Matzen, 29, an actor in Chicago who's mostly been without
insurance since she turned 21. Though she needs regular care for asthma
and a thyroid condition, she says she's looking for a low monthly
premium because she makes less than $20,000 a year.
Hospitals
are worried that those who rack up uncovered medical bills next year
won't be able to pay them, perpetuating one of the problems the new
health care system is supposed to solve.
The
new federal and state health insurance exchanges offer policies ranked
as bronze, silver, gold and platinum. The bronze options have the lowest
monthly premiums but high deductibles - the amount the policyholder
must pay before the insurer picks up any of the cost of medical care.
On
average, a bronze plan's deductible is more than $4,300, according to
an analysis of marketplace plans in 19 states by Avalere Health. A
consumer who upgrades to a silver plan could reduce the deductible to
about $2,500. A top-of-the-line platinum plan has the lowest average
deductible: $167.
Comprehensive data on
premiums isn't available, but in one example, a 30-year-old in Chicago
would pay an average of $222 per month for a bronze plan, $279 for a
silver or $338 for a platinum.
The
complexities of insurance are eye-glazing even for those who have it.
Only 14 percent of American adults with insurance understand
deductibles, according to one recent study.
The
danger of a wrong snap judgment is great for those under financial
pressure - especially those with modest incomes who make too much to
qualify for the government subsidies available under the new health care
system. Subsidies aren't available for individuals making more than
$45,960.
Most of the uninsured make less than that, but many still pick the cheapest plans.
"Price rules," said John Foley, a Legal Aid counselor in Palm Beach, Fla., who has been helping people enroll.
Some applicants see the catch.
"The
real big surprise was how much out-of-pocket would be required for our
family," said David Winebrenner, 46, a financial adviser in Lebanon,
Ky., whose deductible topped $12,000 for a family of six for a silver
plan he was considering. The monthly premium: $1,400.
While
the health law makes many preventive services free - such as vaccines,
blood pressure screening and mammograms - most medical care is paid out
of pocket until the deductible level is reached. Some of the new plans
offer limited coverage for certain services before a patient has met the
annual deductible. These services can include primary care, some
prescription drugs and routine care for common chronic conditions such
as high blood pressure and diabetes.
It's unclear how many plans provide this feature, and it may not be easy for consumers to tell.
Lynn
Quincy of Consumers Union, a public policy group, suggests that
consumers narrow their options to five plans, then go to each insurer's
website to read the benefits summary. It spells out who pays what for
two common situations: having a baby and managing Type 2 diabetes.
To
be sure, the new health law did away with the whopping deductibles in
plans previously offered to people without employer-provided coverage.
Out-of-pocket costs are now capped at $6,350 for individuals and $12,700
for a family.
But some people who have been
paying their own medical bills, or leaving them unpaid at the hospital,
seem surprised that health insurance doesn't cover more of the costs.
"They
previously had no insurance coverage at all and so they might not be
happy," said Cynthia Rahming, an enrollment counselor in Houston.
Fearing
the sticker shock, Loyola University Health System in Chicago is
offering payment plans to spread the out-of-pocket costs.
Some who had private insurance policies that were canceled may find that keeping the same deductibles may mean higher premiums.
In
California, Diane Agnone complained in an online post on her state's
health marketplace. "How is this affordable? I am a healthy 62-year-old
single woman and these new premiums will cost me over $200 more per
month than my existing plan."
The new insurance system requires policies to cover more services than some consumers had chosen to buy in the past.
"It's
all a matter of having a budget and it only goes so far," said Agnone,
an executive with a nonprofit charity based in Fairfield, which is about
halfway between San Francisco and Sacramento. "There is no winning in
this."
