By Rose Hoban
Graphic by Steve Tell

As consumers continue to have problems accessing the troubled website to buy insurance, this calculator can help you determine how much insurance available on the federal exchanges could cost.

These insurance figures come from data released by the federal Centers for Medicare and Medicaid Services in September. At North Carolina Health News, we’ve arranged the data into this convenient map that shows what insurance could cost you in your county.

Under the Affordable Care Act, North Carolina was divided up into 16 areas, each of which has a slightly different set of insurance rates and is represented by different colors in the map.

Don’t forget to select your age, here:

Data courtesy Centers for Medicare and Medicaid Services

The rates, which were reviewed and approved by the N.C. Department of Insurance during the past year, vary based on a number of factors including the number of hospitals and medical providers in the region, how much competition there is among the various providers, the local cost of medical care, the number of people in the area and how sick or well they’ve been in the past. But insurers can no longer charge more for women, deny people based on pre-existing conditions or impose lifetime caps on coverage.

“If your plan is ACA-compliant, those restrictions will no longer apply starting in January,” said Kerry Hall, DOI’s director of public information.

“Under the ACA, beginning in 2014 insurers can only price plans based on age, whether or not you use tobacco, geography and family composition,” Hall said. “The federal law also stipulates that older people can only be charged three times more than people in the under-30 age group.”

Another factor is family composition; if you had others covered under your policy, that would affect your premium.

Hall said DOI was still waiting for guidance from federal authorities about whether those restrictions would continue to apply to plans that are being reinstated as of mid-November.

Under the new law, several different levels of insurance are available:

  • Bronze – these plans cover about 60 percent of the total anticipated cost of care. Consumers who buy bronze plans trade lower monthly premiums for higher out-of-pocket expenses, such as copays and deductibles.
  • Silver – these plans cover about 70 percent of the total anticipated cost of care. Monthly premiums are higher, but out-of-pocket expenses are slightly lower than the bronze plans.
  • Gold – these plans cover about 80 percent of the total anticipated cost of care.
  • Platinum – these plans cover about 90 percent of total anticipated cost of care, but the monthly premiums are pricey, while out-of-pocket expenses are low. You pay a lot up front but very little if you get sick. Think “Cadillac” insurance.

In short, the more expensive the metal associated with the plan, the more expensive the plan itself, and the more comprehensive the coverage.

However, everyone’s total out-of-pocket expenses will be capped. The idea behind that is to reduce the number of people who declare bankruptcy as a result of medical expenses. The maximum amount people will ever pay for out-of-pocket will be capped at $6,350 for individuals and $12,700 for families.

In addition, consumers who are younger than 30 can buy catastrophic plans that cover just that: catastrophic health events such as accidents or sudden illness.

To get an idea of how much subsidy you might be eligible for, try using this calculator, which was created by the Kaiser Family Foundation.


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