Thoughts on the Affordable Care Act

Big Al

12 years ago

I received two comments yesterday stating that I was distributing false information regarding the ACA.

After reading these comments and giving them more than just a few passing thoughts, I called a good friend who is an expert in this field. He has evolved into being a member of senior management of a major health care provider. Here is his response to to the comments:

“My thoughts….

1. The listener is correct, there is an open enrollment period for acquiring coverage through the exchange. Coverage may also be secured outside of the enrollment period for qualifying events, e.g., dependent’s who age-in (turn 27 years old) and acquire their own coverage, or a new dependent child.

2. The only way this listener is paying a $10/premium is if they are on a subsidized plan. I provided below the rates for a commercial Silver plan (basic plan with a typical $3,500 deductible for non- smokers) through the Exchange. The listener is missing the point, since he/she isn’t paying the full cost, we (the tax payers) are.

Iowa is commonly referenced as an a standard exchange.

Iowa Health Insurance Exchange – Sample of Individual Health Plan Rates

According to the Iowa Insurance Division, sample mid-range (Silver) individual plan premiums from the four carriers include:

CoOportunity Health: $172/month for a 21-year old, $267/month for a 45-year old, and $516/month for a 62-year old living in Des Moines, IA (non-tobacco user).
Avera: $280/month for a 21-year old, $404/month for a 45-year old, and $805/month for a 62-year old living in Crawford County (non-tobacco user).
Coventry: $175/month for a 21-year old, $254/month for a 45-year old, and $514/month for a 62-year old living in Des Moines, IA (non-tobacco user).
Gundersen: $306/month for a 21-year old, $467/month for a 45-year old, and $877/month for a 62-year old living in Iowa County (non-tobacco user).

Here is a detailed look at sample rates:

According to the Insurance Division, health insurance plan prices vary both between and within states, based on actuarial tables. Premium costs, the monthly amount an individual and/or an employer pays to an insurance company, may vary depending where someone lives in Iowa, their age, and their tobacco usage.

The state is divided into seven regions (see region list below). All plans through the Iowa Health Insurance Exchange will be categorized by Platinum, Gold, Silver, and Bronze tiers of coverage. For instance, a platinum plan will have a higher monthly premium but lower out-of-pocket expenses for medical care. With a bronze plan, the monthly premium will be lower but have higher out-of-pocket expenses for medical care.

The sample rates are premium rates before any applicable individual health insurance tax subsidies are applied. If eligible for the tax subsidies, the actual amount a person would pay would be reduced at the time of purchase. The tax subsidies are available for consumers with income four times the federal poverty line (making up to ~$45,900 for an individual and ~$94,200 for a family of four in 2013).” For sample health insurance tax subsidy charts, see this article.