Tuesday, April 24, 2018

Consumers need to know more than premiums before buying an Obamacare plan

The biggest problem Wesley Chapel insurance agent Rob Hamilton faced this week was the overloaded Obamacare website that after three days was still keeping shoppers out.

But Hamilton says his next problem will be even bigger: convincing customers that the cheapest plans aren't always the best deals.

For example: A $305-a-month Florida Blue plan may be one of the lowest-price options for a 50-year-old Tampa resident. But what about actually using it?

Its $6,250 deductible means this 50-year-old would have to spend that much out of pocket before the plan covers any care beyond some preventive services. Plus, it's a "bronze'' plan, meaning once it did kick in, it would cover only about 60 percent of average costs. He would be on the hook for the rest.

And his choices for care would be limited: Moffitt Cancer Center and facilities owned by BayCare Health System, the area's largest provider, are not part of the plan's network.

For another $80 a month, that same Tampa resident could buy a Florida Blue "silver" plan, covering 70 percent of costs, that does include Moffitt and BayCare. For another $200 a month, he could buy a "platinum" plan covering 90 percent of costs with an ultra low $850 deductible — and vision and dental care.

Plus, if this 50-year-old makes less than about $46,000 a year, he would likely qualify for subsidies that would lower premiums.

All these factors add up to a complicated decision for many consumers, especially those who have never shopped for health insurance. While premiums often get the most attention, insurers and consumer advocates are warning consumers to consider everything from deductibles and coinsurance to which doctors participate and which drugs are covered.

"When you're able to get to the (healthcare.gov) site and look at it, don't stop at the premiums," said Florida Blue senior vice president Jon Urbanek.

The online insurance marketplace, which went live on Tuesday, is a website where millions of Americans should be able to shop for a private insurance plan and qualify for subsidies. These marketplaces, also known as exchanges, are aimed at people who can't get coverage through an employer or government programs such as Medicare.

But after millions struggled just to log in this week, the Obama administration released the names of the plans sold in each county, along with the monthly premium prices for a sample of consumers. Hillsborough, Pinellas, Pasco and Hernando plans and premiums are in a searchable, sortable database at tampabay.com/ obamacare. Individual insurer's sites offer more information on the plans' features.

For a 27-year-old, the plans range from a barebones, $119-a-month Coventry One catastrophic plan to a $360 Florida Blue platinum plan that covers 90 percent of average costs. A family of four could pay as little as $565-a-month for a bronze Humana plan to $1,200-a-month for a platinum Florida Blue plan.

Within that range are silver plans covering 70 percent of costs and gold plans covering 80 percent — but beware, within each "metal'' category, prices and other benefits can vary widely.

By far, the biggest player is Florida Blue, which offers 80 different types of plans across the bay area. Its low-premium "Blue Select" plans have limited participating doctors and hospitals. Its "Blue Options" line comes with higher premiums but also better benefits and a wider network.

Urbanek said that in the past, the narrow network plan has been a top seller on the individual market, particularly for relatively healthy people.

Healthcare.gov will provide links to the insurers' websites, where consumers can look up the networks, federal officials said. Many consumer advocates are telling customers to also call their doctors or preferred hospital to double-check they are included in a plan.

Policies vary in how much they will pay for out-of-network providers; some pay nothing at all.

Cigna is selling 10 types of plans in Tampa Bay, all of which have the same provider networks but different cost-sharing provisions, said Ray Smithberger, chief operational officer for Cigna's individual and family plans.

"We wanted to keep it simple for people," he said.

As for prescription benefits, Smithberger said some drugs are covered by one plan and not another, or insurers can differ in how much they charge in co-pays for certain medications.

Smithberger likened shopping on the exchange without help to going to a car lot and being told to pick out a car — without ever having driven one before. So the upside to the healthcare.gov technical problems may be that consumers have more time for research. Policies purchased by Dec. 15 will take effect Jan. 1, and the initial enrollment period lasts until March 31.

Federal officials said Thursday that more than 7 million people visited healthcare.gov in its first two days and that servers and other improvements are being added to handle more volume. Cigna on Wednesday reported enrolling its first Florida resident through the marketplace.

Enroll American, an advocacy group, put reporters in touch with 22-year-old Daniel McNaughton, an Orlando college student who works two part-time jobs and has previously had only catastrophic coverage. He enrolled Wednesday in a gold-level plan that, with subsidies, will cost him $70 a month — "a cellphone bill," he said.

Hamilton, the Wesley Chapel agent, said he has more than 400 people who want to buy coverage, many of whom should qualify for subsidies. He's telling them to sit tight for a couple more weeks. After that, "I think their patience will wear thin pretty quick," he said.

Jodie Tillman can be reached at [email protected] or (813) 226-3374.

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