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Got health insurance rate shock? You may have bad information.

Our Health Law Helper can set you right

Published: October 23, 2013 05:00 PM

I’ve heard from many readers who say their health insurance premiums are going through the roof because of the new health law, and they’re having their doubts about the “affordable” part of the Affordable Care Act.

But when they’ve given me enough information to look into their situation, in almost every case it turns out they’re upset over nothing—because their health costs are not going up after all. They just haven’t been able to find their way to the right information.

That is not surprising. Healthcare.gov, which is the only way to the marketplace for 36 states, is still not working well. And even the state Health Insurance Marketplaces that are operational don’t always make it easy for consumers to understand what subsidies they're entitled to or how they will work. We’ll give details on those problems in future blogs, as well as advice on how to get around them.

But in the meantime, use our interactive tool, Healthlawhelper.org. It will tell you right away what kind of help you may have coming to you, and possibly ease your mind.

Some examples where better information would have prevented rate shock:

Didn't know about major financial help. A retired woman living on $20,400 in Social Security survivor’s benefits said she was struggling to afford her $541 retiree health plan. She said the plans she's seen that are available through her state’s Health Insurance Marketplace would be even more expensive, with worse coverage.

REALITY: At her income level, she’ll not only be entitled to a hefty subsidy that will bring her premium down to about $90 a month, she’ll also get a major reduction in her out-of-pocket costs.

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.

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.

—Nancy Metcalf

   

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