Opinion: Premiums are truly affordable - find out on Healthcare.gov

Submitted by gsbaird on October 23, 2013 - 2:14pm

People may be misinterpreting the information available on the Affordable Care Act's healthcare.gov website. One can now see plans and rough prices for plans available by for any specified county in Texas. However, this can be very misleading in that this information does not include the government tax credits available to most.

When looking at plan prices, click on the link that says 'to find out if you may qualify for lower costs, use this simple calculator.’ The link takes you to the Kaiser Family Foundation website calculator, which is very easy to use. After you input your estimated yearly income and who is to be insured, you will receive an exact amount that you would be expected to pay as your part of the insurance premium. For lower incomes, the government tax credits (subsidies) are high and the credits decrease as income increases.

The amount shown on the Kaiser Family calculator is what you will pay for the second lowest cost Silver plan. In Comal County, this is the Blue Cross Blue Advantage HMO 004 plan. You can disregard the price shown for the plan on healthcare.gov, which is the total price and is only an average based on an age range, not a specific age. What you will actually pay for the premium is shown accurately by the calculator.

A person making $20,000 yearly can purchase this Blue Cross HMO plan for $85 per month.

The deductibles and maximum yearly out-of-pocket amounts vary with income. For the person making $20,000, there is a general deductible of $500 and additional deductibles of $250 for hospital admittance and $200 for outpatient surgery. The maximum yearly out-of-pocket cost (not including the premium but including the deductibles and copayments) is $1,500. The deductible is waived for visits to primary care doctors, specialists, scans and prescription drugs. For these, you have copayments. If you are ill and need to see your primary care doctor, your cost for each visit is $35.

In my view, this plan is affordable, protects the policyholder against major medical costs and enables doctor visits and prescription drug purchases without having to satisfy a deductible. For those who wish access to a broader network and flexibility to visit a specialist without first seeing the primary care doctor, PPO plans are available from Aetna and other insurers at a somewhat higher premium cost.