First details of local health plans on federal exchange released

Posted Thursday, Oct. 03, 2013  comments  Print Reprints

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Three insurers are offering 36 health policies to Tarrant County residents through the new federal exchange, but getting a look at the details of those plans remains a challenge.

Facing problems with access to the Health Insurance Marketplace, as the exchange is known, the Health and Human Services Department released a list of policies Wednesday on all the exchanges run by the government, including the one in Texas. They show the range of premiums that families and individuals will be offered, but not important elements such as deductibles and other potential out-of-pocket costs.

Blue Cross Blue Shield of Texas, easily the state’s largest health insurer in the individual and small-group market, is offering half the plans on the exchange for residents of Tarrant County. The other insurers are Cigna and Aetna.

Rates for a 27-year-old range from $152.71 a month for a bronze plan, the lowest level of coverage, to $387 for a gold plan. Rates for a family of two 30-year-olds and two children range from $515.84 a month for a bronze plan to $1,308 for a gold plan.

Rates are higher for older people but can’t be more than triple the rate charged young people. Insurers can also charge smokers up to 50 percent more.

Plans are classified as bronze, silver or gold, depending on what percentage of likely medical costs are covered.

The final cost to an individual or family depends on household income. Tax credits are available to households earning 100 to 400 percent of the federal poverty level, which is $11,490 for an individual, $19,530 for a couple and $23,550 for a family of four.

John Merrifield, president of IFC Benefit Solutions in Fort Worth, said the premium is only half the story. It’s also necessary to look at deductibles, co-pays for doctor visits and tests, and total out-of-pocket cost, he said.

Merrifield, like most, had not been able to see the plans listed on the Texas exchange. He said his firm deals mostly with businesses buying benefits for their employees but also sells individual policies.

He said many small employers renewed their existing insurance packages early so the plans would carry well into 2014 before they had to redesign their benefits to meet new rules. For those that did not, the coverage appears to “be a little more expensive,” he said.

“But I will say that for people who had trouble getting insurance before, it’s a good thing,” Merrifield said.

Plans on the exchange must offer 10 “essential health benefits” and may not charge more to people with pre-existing conditions.

While the tax credits can greatly reduce premiums for low-income households, it’s also important to calculate how much “cost-sharing” is available to help pay deductibles and other out-of-pocket costs, he said.

“That may be one of the least-understood elements of this whole thing,” Merrifield said.

For example, a silver plan is designed to cover 70 percent of anticipated medical costs, with the insured picking up 30 percent. But households with incomes of 100 to 150 percent of the federal poverty level will be responsible for just 6 percent of covered expenses.

Total out-of-pocket costs are also subject to cost-sharing. Rather than the maximum out-of-pocket cost of $6,350 allowed on exchange plans for an individual, a person earning less than 200 percent of the federal poverty level would see that capped at $2,250.

Jim Fuquay, 817-390-7552 Twitter: @jimfuquay

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