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ACA Marketplace Premiums
09/25/2013   Reported By: Patty B. Wight

Some good news for those following developments in the federal health reform initiative known as the affordable care act....except if you live in Maine. A new federal report finds that the average prices for insurance on the soon-to-be-open online Marketplace are lower than anticipated. But the cost of health insurance products in Maine rank among the highest in the nation. Still, advocates insist, the sticker price doesn't necessarily reflect the final cost for consumers.

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According to a report released Wednesday by the US Department of Health and Human Services, the cost for a mid-level, so-called 'silver' plan on the marketplace in MAINE is just over 4-hundred dollars a month, compared to the national average of 328 dollars a month.

But Mitchell Stein of consumers for Affordable health care says if you're one of the eight to ten percent of Mainers who are expected to shop on the online Marketplace, you won't necessarily have to pay that much.
"It's like buying a car. Ya know, when's the last time you paid sticker price for a car?"

And Stein says its important to factor in tax credits, which are available to those making between 100 and 400 percent of the poverty level.

"And the way the premium tax credits are calculated, it's requiring individuals to spend a certain percent of their income toward their health insurance premium. And so that has a way of smoothing out the differences across the states."

For a family of four that earns 50-thousand dollars of income, the average sticker price for a mid-level silver plan varies widely from state to state- anywhere from about 600 dollars a month to over a thousand. But after the tax credit - which can be applied upfront - the monthly price comes down to 282 dollars in nearly every state. If you're a 27 year old making 25-thousand dollars a year, tax credits bring mid-level premium prices down to 145 dollars a month. But there is a caveat to all this, cautions Caroline Pearson of Avalere Health, a Washington, DC based health care consulting firm.

"We believe these plans are maintaining very low premiums by restricting the scope of their provider network, and by really including fewer physicians and hosptials in their network. That's how they're keeping prices down."

In Maine, Anthem Insurance embraced the narrow provider network, striking a deal with certain hospitals in order to reduce premiums by 12 percent. The other company offering products on the Marketplace - Maine Community Health Options - opted for a broad network. Aside from limited consumer choice in some plans, says Pearson, there 's also the issue of high deductibles.

"In a silver product for example, average deductibles will be a little over 2500 dollars a year. So for some folks, that may be very expensive out of pocket costs before their benefit design kicks in and they receive any benefit from the coverage."

But Mitchell Stein of Consumers for Affordable Health Care points out that the maximum deductible for any plan in the Marketplace is about 6300 dollars, which is a vast improvement compared to what individuals currently pay for their own insurance.

"Right now the average deductible sold in the state of Maine is 15-thousand dollars."

Plus, Stein says, some individuals will qualify for federal subsidies to help pay their deductible. Both Stein and Pearson say if you need to shop on the online marketplace - meaning, you don't have employee insurance or Medicare - take your time, compare plans, and ask for help to get the best bang for your buck.


Report on Health Insurance Marketplace Premiums for 2014

 

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