“Affordable” Care Act?

Oh sorry – you thought I was done bitching about the impacts of the Affordable Care Act?   In the words of Al Pacino’s Colonel Slade from Scent of A Woman:


So today I was sent some information on preliminary pricing of Anthem health insurance plans in New Hampshire under the Affordable Care Act.   First, sample premiums for Guys Like Me who buy their own insurance and don’t qualify for subsidies:


I don’t know why the plans cost more – and have higher deductibles –  if you buy them direct from Anthem as opposed to if you buy them on the Exchange.  Anyone?  The obvious answer is “they want you to buy from the exchange” but it should be the same provider network either way, so what’s the economic impact for the insurers/doctors?  I don’t get it.  By the way, an Anthem rep advised me via email a few weeks ago that I should buy from Anthem if I already have coverage with them.  Umm – no thanks – that seems like a terrible idea…

We won’t dwell on the fact that it looks like my new premiums will be at least 40% higher than they currently are (with a slightly lower deductible), and that I will lose access to my local hospital and doctors therein.  Moving on.

Now the premiums for Those Who The Affordable Care Act Is Really Supposed To Help:  those who can least afford health insurance.


This seems like a good time to remind you that I am not a Scholar of Healthcare.  I’m just a pragmatist trying to figure all this stuff out via my real world experiences and interactions with the System.   Thus far, I’ve figured out that I’m pretty much The Guy getting screwed over here:  I’m in that tiny minority that already buys his own individual coverage and will lose access to doctors and hospitals I currently use.  I’m in that tiny minority who won’t have a hospital within 20 miles of his home.  But hey – I hope the ACA at least helps those who it intended to help, which is my point of discussion here:  are these plans going to be Affordable for those who most need them?

Take a quick look at those purple bars: that’s the “most poverty-ish” group.  Once you take into account the tax subsidies and cost sharing, the monthly premiums for the Bronze plan are $0.   But what about that $11,500 deductible for a family of 4?   How do you afford that if you’re making $ 23k a year?   Is that where cost sharing comes in? (I don’t know these answers)…    So let’s check the silver plan:  $36/month and a $ 1k deductible?  That’s not horrible coverage, actually, right?  I think there must be a typo in these purple bars, though: the silver plan wouldn’t have a higher deductible than the gold plan would, right? That would make no sense… I’m going to assume those two are reversed, and that it’s really a $ 2k family deductible for the silver plan.   $ 2k is probably a lot of money for those in this bracket – probably not very “affordable” when you’re only making $ 23k a year or less?  We’ll see, I guess…


I think the graphics above are missing a key piece of information: out of pocket maximum… Anthem is quoting these plans in a funny way: normally you’d assume that once you meet your deductible, you don’t pay any more for in-network coverage, right?  well, look at this from Anthem’s guide:

Co-insurance: This is the percentage of the cost of covered services that is shared by you and your insurance company after you’ve met your deductible. So if your co-insurance is 20%, your insurance company pays 80% of the cost of in-network care and you pay the remaining 20%. For example, if a doctor’s office visit costs $100, your co-insurance payment would be $20.”

In other words, those deductibles above aren’t out of pocket maximums: you pay the deductible, and THEN you pay co-insurance for another $ X amount that we don’t yet know – an amount that is essential to evaluate the potential costs…  This makes the plans significantly more expensive, of course.

Instead of rehashing the stuff I’ve already covered, let me just refer you to my related posts:

I Have Solved National Healthcare

The President Lied To Me – ACA Edition

Health Insurance Needs Reform

My Health Insurance Bill Just Increased By 48%

to be continued…


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