Believed misleading info from insurance company. A California freelancer was irate that her insurance company was discontinuing her existing, zero-deductible plan and replacing it with a plan with a higher premium and much higher out-of-pocket costs. “It’s sad the way this is working out for some moderate-income people,” she said.
REALITY: I plugged her age, ZIP code, and income ($35,000) into the plan preview feature of Covered California, the state-run marketplace (which is up and running, by the way). Turns out that with her subsidy, she can buy a plan from the same carrier for $134 a month less than what she’s paying now. The deductible is comparable to the replacement plan she was offered but the copays are similar to those of her current plan, and most of the services she’s likely to need aren’t subject to the deductible anyway, such as doctor visits, generic drugs, lab tests, and hospital care.
Unaware of CHIP eligibility. A dad from Washington state lamented that he and his four kids are caught in the infamous family glitch. His wife pays nothing for her own coverage through her job, but to add the rest of the family costs $1,600 a month, which eats up nearly a fifth of their $80,000 annual income. Yet because of the glitch, they can’t get subsidies to buy coverage on the Washington Healthplanfinder (another state-run marketplace that's working fine).
REALITY: I ran this family’s numbers through HealthLawHelper.org. It turns out all four kids are eligible for health coverage through Apple Health, the state’s CHIP program, for a total cost of less than $100 a month. As a matter of fact, they can enroll right now and not have to wait until Jan. 1. The dad can then compare his wife’s plan and unsubsidized marketplace plans to see which suits his needs and pocketbook better. A 45-year-old can buy an unsubsidized Group Health Silver plan with a $1,500 deductible for $404 a month on the marketplace.
Got a question for our health insurance expert? Ask it here. It helps if you include the state you live in.