I get a lot of letters from people angry because, they think, the new health care law is leading to higher premiums for them. But when I dig into their stories, it seems that confusion and a rush to blame the Affordable Care Act are to blame. Consider these two stories:
Q. I used all my savings to pay medical expenses during a prolonged period of unemployment and health problems. I now have a job paying $40,000 a year to support myself and my son, a college student. My new employer doesn’t offer health insurance. The Kaiser subsidy calculator says I’ll be paying a monthly premium of $3,267. I can’t afford this! Obamacare will destroy me.
Q. I’m a Florida retiree on Medicare, but my wife is 57 and needs insurance. We live on my Social Security, $19,000 a year. What’s my choices? I hate Obummercare. Higher prices. High deductibles.
In fact, both these people are in line for major financial help to purchase health insurance.
The distraught Pennsylvania dad's mistake was easy to spot. He didn’t notice that the Kaiser Family Foundation’s subsidy calculator presents its results by the year, not the month. This father and son will actually be able to buy a Silver (midpriced) plan for $272 a month for both of them on their state’s Health Insurance Marketplace.
I used that same calculator to determine the cost of an “Obummercare” plan for the Florida man’s wife. The results showed pretty much the opposite of the “higher prices, higher deductibles” he was apparently led to expect. Because their income is barely above the poverty level, they will receive an enormous premium subsidy and his wife’s plan will cost $32 a month, less than the tab for a dinner for two of them at a sit-down chain restaurant.
Again because of her very low income, this premium entitles her to a special “Silver 94%” plan with extremely low out-of-pocket costs. I don’t have access to the specifics of these plans in Florida, but in California, a Silver 94% plan has a $0 deductible, a $3 copay for doctor visits, lab tests, and generic drugs, a $5 copay for specialist visits, X-rays, and brand name drugs, 10 percent coinsurance for hospitals and other high-cost services, and an annual out-of-pocket limit of $2,250.
It is true that not everyone will come out so well. A small number of people really are having to give up decent individual insurance that will be replaced with more costly or less generous coverage. But don’t let the politics surrounding the law discourage you from exploring your options. Not to sound like a broken record, but a good place to start is our free intractive tool, HealthLawHelper.org, which will tell you if you are in line for financial help and let you know what to do next.
Got a question for our health insurance expert? Ask it here; be sure to include the state you live in. And if you can't get enough health insurance news here, follow me on Twitter @NancyMetcalf.
Health reform countdown: We are doing an article a day on the new health care law until Jan. 1, 2014, when it takes full effect. (Read the previous posts in the series.) To get health insurance advice tailored to your situation, use our Health Law Helper, below.
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