Obamacare and you: Letters hold evidence of insurance's rising costs

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Posted: Tuesday, September 17, 2013 12:00 am

Letters going out to 45,000 Nebraskans who buy their own individual and family health insurance make it clear:

Because of the Affordable Care Act, their deductibles and copayments are going up if they pay the same monthly premiums. Or they can pay higher premiums if they want to keep similar deductibles and copayments.

“I'm being slammed into a bronze plan with no options of other insurance except exchange bronze, silver or gold,” said Mike Kennedy, an Omaha attorney who serves on the Millard school board. The politically active Republican got his information from Blue Cross Blue Shield of Nebraska on Saturday.

Actually, Kennedy has choices — 14 of them within Blue Cross because he lives in the Omaha area. Those outside the area can choose from 11 different policies. Until now, Blue Cross has had about 100 different plans, covering about 88,000 people. And other insurance companies are offering policies under the Affordable Care Act, also known as Obamacare.

But it's true that his Blue Cross choices are the bronze, silver and gold plans that will go up for sale starting Oct. 1 on the state exchange, also known as a marketplace, being organized under the Affordable Care Act. The same plans will be both on the marketplace and off, Blue Cross spokesman Andy Williams said.

Kennedy's “renewal packet” includes a sheet comparing his current policy and the bronze policy that has the closest monthly premium. The packet also describes other options, including plans with better benefits and higher premiums.

The policies are rated as bronze, silver or gold depending on what share of medical costs the insurer will pay. Blue Cross isn't offering a “platinum” plan, which would have the richest benefits and the highest monthly premiums.

Policyholders can talk to their agents or call Blue Cross to find out more about their choices, Williams said, and plenty of people are doing just that. By 10 a.m. Monday, about 200 people had called Blue Cross to talk about their options. The packets are being mailed in batches over the coming two weeks.

The information includes a “quick check” method of estimating whether a policyholder may be eligible for tax credits through the marketplace to subsidize monthly premiums.

Williams said about half the people may qualify for tax credits. “There's a lot of differences to understand in the new world. They are all new plans to look at.”

The new plans are different because the law requires that they add coverages that many existing policies don't include and because of other provisions of the law, which includes an “individual mandate” requiring Americans to carry health insurance.

Besides the comparison with the bronze plan with the closest monthly premium, Williams said, the packets show the other options. If customers want greater benefits, they can choose a plan with a higher monthly premium.

But there's no going back to the old plans, he said, even outside the marketplace.

Blue Cross and other insurers adapted their old plans or drew up new versions to meet the requirements of the law. The plans have been approved by the Nebraska Department of Insurance, which regulates insurance in the state, and the federal Centers of Medicare and Medicaid Services, which oversees the Affordable Care Act.

In one of the Blue Cross letters, the annual deductible for the new BlueEssentials Plus plan would be $3,500, up from $1,000 in the comparable-premium policy that expires Dec. 31, and double those amounts for a family. The out-of-pocket limit would increase to $6,350 (the federal limit) from $3,000. Copayment for an office visit would increase to $60 from $40.

On the other hand, the new policy would cover maternity, pediatric dental, pediatric vision, mental illness and substance abuse services, which were not covered in many previous plans.

Those are among the “essential” benefits required by the law. The others are hospitalization, outpatient care, emergency services, prescription drugs, rehabilitative services, laboratory services, chronic disease management and preventive and wellness services. Some of those benefits are not covered in current plans.

Some policies today don't include those coverages, either, Williams said.

Obamacare also has other protections, including guaranteed issuance of a policy, coverage of pre-existing conditions and no policy cancellations without showing fraud.

Kennedy, the Millard attorney, said he doesn't want to use the marketplace or the tax credits.

“The government's never subsidized me before,” he said. “Why should someone else have to pay for my health insurance?”

If he wants better benefits, he said, “I can pay hundreds of dollars more a month. They were nice enough to make the (BlueEssentials Plus) premium within $10 of what I paid before,” he said with a touch of sarcasm, but he would rather have a lower deductible.

“These things come at a price,” he said. “They're not free, and now we're seeing what that price is.”

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