What we're learning: Affordable Care Act
Low monthly costs, high deductibles
It's been nine days since the Affordable Care Act's companion website Healthcare.gov came online for Texas residents. What was expected to be a flood of information, instead turned out to be a trickle after issues arose. Many people still haven't made it through the hoops and barrels of the website. Even fewer have had a chance to see the plans they qualify for.
According to Project Amistad, a nonprofit working with people to help guide them through the new rules tied to ACA, only two people that they're aware of have successfully gotten through the website to get new information; one of them is an employee at ABC-7.
What our employee found were a wide range of monthly rates, but sky-high deductibles on many plans. A deductible is the amount of money an insured patient pays out of pocket before their insurance kicks in and foots a portion the bill.
For a 50-year-old non-smoking white male, a monthly rate for a bronze plan could be as low as $202.91 a month. It would also carry a deductible of $6,000. That means in a "worst case scenario," a person could find themselves in the hospital with $6,000 to pay out of pocket before insurance kicks in. The cheapest "silver" plan, or mid-range insurance plan, would cost our employee $287.76 a month while carrying a $6,000 deductible as well. That employee did find a silver plan with no deductible for $430 a month. That plan, from Molina Marketplace, would pay 70 percent of a policyholder's medical bills after the employee made a copayment for each office visit of $30 to $75.
A study by Avalere Health found the same result. Despite low monthly payments to get insurance, the amount that comes out of pocket is a much deeper cost. The independent analysis found that the average deductible for a "silver" or mid-range plan in six sample states was $2,550. That deductible is twice the average cost of employer-driven insurance plans in those same states. Americans looking for a health plan will face a trade-off familiar to purchasers of automobile coverage: to keep your premiums manageable, you agree to pay a bigger chunk of the repair bill if you get in a crash. Except that unlike an auto accident, serious illness is often not a self-contained event.
"Consumers will need to balance lower monthly premiums against the potential for unpredictable, expensive out-of-pocket costs in plans with higher deductibles," said Caroline Pearson, a vice president of the private market analysis firm. "There is a risk that patients could forgo needed care when faced with high up-front deductibles."
Responding to the Avalere study, the Obama administration acknowledged the new plans aren't as generous as employer coverage, but said they nonetheless represent a big improvement over currently available individual policies, which can have gaps in coverage and even larger out-of-pocket costs.
Looking for more information on local reaction, ABC-7 contacted Project Amistad to get reaction on the high deductibles. That's when another storyline emerged. According to Ramirez, they've had more than 300 people come to them requesting help but those numbers are dwindling. She said that most people have "given up at this point," after there were issues getting information online. Ramirez told ABC-7 that the general feelings is that people will have to wait until more glitches are fixed, allowing people to freely get onto the Healthcare.gov website.
The ACA requires people to be signed up for insurance beginning Jan. 1. If they're not signed up, they face penalties. At the same time, the health care law will prohibit insurance companies from turning away people in poor health, or charging them more.
Copyright 2012 KVIA. The Associated Press contributed to this report. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.