By Yen Duong and Rose Hoban
If you thought an Obamacare plan might cost you too much, think again. In fact, you could pay nothing.
As this year’s enrollment period for insurance through the Affordable Care Act draws to a close, advocates are making the point that some plans could actually cost nothing, after tax credits.
But Adam Zolotor from the North Carolina Institute of Medicine said that consumers should look at their options carefully.
“If you actually have need for health care you could end up spending more money on a bronze than a silver plan,” he explained. “That’s because under silver plans, which cost a little bit more, the federal government not only pays for a tax credit but also gives consumers help covering their out-of-pocket costs.”[sponsor]
“If someone is pretty healthy and not expecting to go to the doctor except for an annual physical they might benefit from a bronze plan, it allows them some measure of insurance against a major calamity,” he said. “Having a bronze plan for some people actually winds up meaning that they have more out-of-pocket expenses.”
Read the fine print
Though a free bronze plan may sound tempting, the average deductible for bronze plans is $6,258 and there’s no help on bronze plans for out-of-pocket costs. That means a consumer has to pay off that deductible before the health insurance kicks in and starts paying for services.
ACA plans are organized into metal tiers, based on what percentage of your health costs they cover, as listed on healthcare.gov. Bronze plans will pay for 60 percent of health costs, leaving consumers who buy them responsible for 40 percent of any costs to come out of their pockets.
In contrast, silver plans cover 70 percent of costs and typically have lower deductibles, ranging from $239 to $3,169 in 2019. On top of that, the federal government provides help to cover out-of-pocket costs.
People who make less than 250 percent of the federal poverty level are eligible for help with out- of-pocket costs in the ACA marketplace, but they can only use these extra savings on silver plans.
For instance, a family of four in Charlotte that makes the median household income in Charlotte of $58,202 may be better off paying $373 a month (7.7 percent of their income) for a silver plan with lower deductibles than choosing a $0 bronze plan. This median income is 232 percent of the federal poverty level.
A family of four in Henderson that makes the median household income in Henderson of $26,256 would pay $46 a month for a silver plan, or $0 for a bronze plan. This median income is 105 percent of the federal poverty level.
Those silver plans premiums cost more per month than bronze plans, so there’s a trade-off: pay per month up front for a silver plan with better coverage, or pay next-to-nothing up front for a bronze plan and take your chances you don’t get sick and saddled with high out of pocket costs.
Zolotor said it would be wise to sit down with an enrollment counselor or a navigator to discuss what works best. He said that, for instance, low-income adults who get their care at federally qualified community health clinics could be paying very little if they’re being charged on a sliding scale already. Having insurance might not actually work for those people. Zolotor also worried that those low-income people who qualify for their local hospital’s charity care program might be on the hook for more out-of-pocket costs if they end up in the hospital and they have purchased that bronze-level coverage.
“We might wind up seeing people with more out-of-pocket expenses because they’re newly insured,” he said. “I don’t think that’s the system they’re shooting for.”
Mark Van Arnam, head of the NC Navigator Consortium, said that while those bronze plans look tempting, the folks working with him are careful to comb through the policies with potential enrollees.
“If they take prescription drugs that they’re included in the formularies for these plans, we want to make sure that their costs are minimized and there’s no out-of-network costs that may increase the price for them,” he said.
As of Dec. 1, 184,891 North Carolinians had signed up insurance, a number that’s down from last year, when 209,050 people had signed up by the start of December.
Van Arnam said he’s been driving around the state talking to people and attending enrollment events.
“I think I spend more time in my car than I do in my own bed at home,” he said during an interview with NC Health News conducted as he was driving. “I’m living off of Diet Coke and adrenaline.”
He said that while enrollment is lagging somewhat, there are some extenuating circumstances, the first being the elimination of the individual mandate that penalized people for not purchasing insurance. And, he said, the state’s improved job market has softened demand.
“There are people who are going out and getting employer based coverage, so that also means there are less folks that are needing to use the marketplace,” Van Arnam said.
Nonetheless, as the Saturday midnight deadline looms, activity has ticked up in both the state’s call center and online.
“We know always that folks are natural procrastinators, and they tend to act in this last week of open enrollment,” he said.
Van Arnam worried that this past weekend’s winter storm forced the cancellation of a number of walk-in enrollment events and those where people had signed up in advance for appointments.
“We’re concerned about that, we want to be sure that everyone has the opportunity to take action and get enrolled,” Van Arnam said.
He noted that his organization has petitioned the federal Centers for Medicare and Medicaid Services for a deadline delay of several days for people affected by the snow, but he has yet to hear back from federal officials.