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Different counties, different prices for health insurance

One resident contemplating choices

Published: Saturday, Dec. 14, 2013 1:15 a.m. CDT
Caption
(Alex T. Paschal/apaschal@saukvalley.com)
Mary Sweeney reviews a health insurance policy in her Oregon home. Sweeney, 62, recently had her insurance company cancel her policy because it didn't meet the standards under the Affordable Care Act. She since has been informed she would get an extension, but has yet to get the documentation from her insurer.

Mary Sweeney, 62, is a little more confident that she will have health insurance next year. 

Recently, the Oregon resident’s insurance company canceled her policy because it didn’t meet the standards under the Affordable Care Act, known as Obamacare. 

But President Barack Obama then announced that he would allow insurance companies to extend existing below-standard policies for a year.

Afterward, Sweeney, like others in the area, was informed she would get such an extension. But she has yet to get followup documentation from her insurer, which has her a bit worried.

Her husband is taken care of; at 66, he’s on Medicare. She is 4 years away from benefiting from that program, which is for Americans 65 and older. 

Now, her policy has a $267-a-month premium, with a $3,500 deductible. 

If she went on the health insurance exchange at HealthCare.gov, she would find only more expensive policies.

One Blue Cross Blue Shield policy has a $3,750 deducible for someone her age in Ogle County, but the premium is $517. And the total out-of-pocket costs are $6,250, with 30 percent coinsurance for seeing primary care and specialist doctors and getting generic prescriptions. Under that policy, a visit to an emergency room would cost Sweeney a $600 copay and 30 percent coinsurance after the deductible.

But her premium will probably be lower, she said, because she would likely qualify for subsidies under Obamacare because her income is low. Her husband works part time, and she is a substitute teacher.

Still, she has contemplated not having insurance at all until she turns 65. 

“I asked my husband whether I could do without,” Sweeney said. “He said no.”

She has no major health issues, she said.

“I’m on medications for high blood pressure,” she explained. “I do need to see the doctor periodically.”

Website working much better

When the Obama administration rolled out HealthCare.gov in October, it was slow and error-plagued. Few people could enroll for insurance because of the problems.

Obama brought in leading tech experts, and over the past couple of weeks, the website has improved a lot. Perhaps it’s one of the faster sites on the Internet. 

You can check and compare what insurance policies cost. The rates change according to your state and county.

Under the exchange, insurance companies can consider only three things when giving a price for insurance – your age, whether you smoke, and your community rating, which is based on an area’s demographics.

Let’s look at a 40-year-old nonsmoker. What would his insurance cost?

Under one of Blue Cross Blue Shield’s Bronze plans, this man’s premiums would be $139 a month, with a yearly deductible of $6,000 in Whiteside and Bureau counties. That’s significantly better than in Lee and Carroll counties, where it would include a $219 premium, with the same deductible. None of those policies has a copay.

Ogle County is in the middle with a $169 premium, plus a $6,000 deductible and $6,250 out of pocket because of copays.

Think it’s better in the big city?

Not necessarily. The same policy would have a $152 premium in Cook County, along with a $6,000 deductible.

While Whiteside County nonsmoking 40-year-olds will see better prices, others in the county may not see an advantage. 

Look at a family with two 40-year-old parents and two children, 15 and 10. 

Under one of Blue Cross Blue Shield’s plans, such families in Lee, Carroll and Ogle counties would pay $157 a month with a $12,700 deductible and $25 for visits with primary care doctors.

In Bureau and Whiteside counties, that plan has a $168 premium, with the same deductible and charge for doctors.

In Cook County, the policy is actually more expensive – a $171 premium with the same deductible and a $20 charge to see primary care doctors.

None those prices reflect the lower costs that people may qualify for based on household size and income, according to the website.

Households with incomes up to about $46,000 for individuals and $94,000 for a family of four will qualify for lower costs, the site says.

Spread out the risk, expert says

Why are there different prices around the state?

“Medical costs are higher in some counties,” said Julian Reif, a finance professor at the University of Illinois. “If a hospital has more market power, it can exert higher prices.”

The higher levels of obesity in rural areas can also have an effect, Reif said. 

“The reason prices are going up is the new regulations and the benefits under the Affordable Care Act,” Reif said. “There are more benefits. Are the benefits worth the money? Conceptually, there are a lot of benefits you don’t use. The intention of the law was to pool everyone together.”

Some older residents have complained that the Affordable Care Act requires policies have coverage for birth control and maternity care.

It works both ways, Reif said, as younger people don’t need as many medical services.

“Younger individuals will pay for older people who tend to get sick,” he said.

For insurance to work, society has to spread the risk among a broad group of people, said Robert Rich, retired director of the Institute of Government and Public Affairs at the University of Illinois.

“If you can’t spread the risk out, only the sick will take the insurance,” he said. “That will jack up the price of the premium.”

That means the young and invincible will have to sign up in greater numbers, but is that happening?

“My sense is that it isn’t,” Rich said.

Those people will be subject to a penalty for not having insurance.

The costs of insurance

Here's a look at the costs of insurance under the Affordable Care Act in the Sauk Valley and Cook County:

COMPARISON NO. 1

Nonsmoking 40-year-old

(Blue Cross Blue Shield Blue Choice Bronze PPO 006)

BUREAU COUNTY

Premium: $139

Yearly deductible and out-of-pocket: $6,000

Primary doctor: No charge after deductible

Specialist doctor: No charge after deductible

Generic prescription: No charge after deductible

ER visit: No charge after deductible

CARROLL COUNTY

Premium: $219

Yearly deductible and out-of-pocket: $6,000 

Primary doctor: No charge after deductible

Specialist doctor: No charge after deductible

Generic prescription: No charge after deductible

ER visit: No charge after deductible

LEE COUNTY

Premium: $219

Yearly deductible and out-of-pocket: $6,000

Primary doctor: No charge after deductible

Specialist doctor: No charge after deductible

Generic prescription: No charge after deductible

ER visit: No charge after deductible

OGLE COUNTY

Premium: $169

Yearly deductible: $6,000

Yearly out-of-pocket: $6,250

Primary doctor: $25

Specialist doctor: $100

Generic prescription: 30% Coinsurance after deductible

ER visit: $600 Copay and 30% Coinsurance after deductible

WHITESIDE COUNTY

Premium: $139

Yearly deductible and out-of-pocket: $6,000

Primary doctor: No charge after deductible

Specialist doctor: No charge after deductible

Generic prescription: No charge after deductible

ER visit: No charge after deductible

COOK COUNTY

Premium: $152

Yearly deductible and out-of-pocket: $6,000

Primary doctor: No charge after deductible

Specialist doctor: No charge after deductible

Generic prescription: No charge after deductible

ER visit: No charge after deductible

COMPARISON NO. 2

Two 40-year-old nonsmoking parents, two children, 15 and 10

(Blue Cross Blue Shield Catastrophic 100 percent PPO Plan)

BUREAU COUNTY

Premium: $168

Yearly deductible and out-of-pocket: $12,700

Primary doctor: $25

Specialist doctor: No charge after deductible

Generic prescription: No charge after deductible

ER visit: No charge after deductible

CARROLL COUNTY

Premium: $157

Yearly deductible and out-of-pocket: $12,700

Primary doctor: $25

Specialist doctor: No charge after deductible

Generic prescription: No charge after deductible

ER visit: No charge after deductible

LEE COUNTY

Premium: $157

Yearly deductible and out-of-pocket:  $12,700

Primary doctor: $25

Specialist doctor: No charge after deductible

Generic prescription: No charge after deductible

ER visit: No charge after deductible

OGLE COUNTY

Premium: $157

Yearly deductible and out-of-pocket: $12,700

Primary doctor: $25

Specialist doctor: No charge after deductible

Generic prescription: No charge after deductible

ER visit: No charge after deductible

WHITESIDE COUNTY

Premium: $168

Yearly deductible and out-of-pocket: $12,700

Primary doctor: $25

Specialist doctor: No charge after deductible

Generic prescription: No charge after deductible

ER visit: No charge after deductible

COOK COUNTY

Premium: $171

Yearly deductible and out-of-pocket: $12,700

Primary doctor: $20

Specialist doctor: No charge after deductible

Generic prescription: No charge after deductible

ER visit: No charge after deductible

Note: The prices here don't reflect the lower costs you may qualify for based on household size and income.Many people who apply will pay lower monthly premiums than those shown here. Households with yearly incomes up to about $46,000 for individuals or $94,000 for a family of four will qualify for lower costs. The prices you see are for people who don't use tobacco.

Source: HealthCare.gov

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