LIVING OBAMACARE – Chicago Tribune, splash atop A1, "Obamacare deductibles may cause sticker shock: Insurance companies are requiring higher out-of-pocket expenses to pay for complying with new rules," by Peter Frost: "Many [Americans] buying health coverage on their own next year will face a … dilemma spurred by the health care overhaul: pay higher monthly insurance premiums or run the risk of having to shell out thousands more in deductibles for health care if they get sick. To promote … exchanges, the online marketplaces where consumers can shop and buy insurance, Obama administration … officials touted the lower-than-expected monthly premiums that would make insurance more affordable for millions of Americans. But a Tribune analysis shows that 21 of the 22 lowest-priced plans offered on the Illinois health insurance exchange for Cook County have annual deductibles of more than $4,000 for an individual and $8,000 for family coverage. Those deductibles, which represent the out-of-pocket money consumers must spend on health care before most insurance benefits kick in, are higher than what many consumers expected or may be able to stomach, benefit experts said. By comparison, people who buy health insurance through their employer have an average individual deductible of just more than $1,100, according to the Kaiser Family Foundation.

"Although millions of Americans will be eligible for federal assistance to help offset some of those costs, millions will not, underscoring one of the trade-offs wrought under the law’s goal to ensure most people have access to health insurance. … Plans with the least expensive monthly premiums – highlighted by state and federal officials as proof the new law will keep costs low for consumers – have deductibles as high as $6,350 for individuals and $12,700 for families, the highest levels allowed under the law. Because the federal website that runs the Illinois exchange remained largely inoperable as of late last week, the Tribune used data from websites of four of the five insurers that will offer plans in Cook County on the marketplace. …

"Insurers say the price and cost hikes result from new benefit mandates, additional taxes levied as part of the law and a requirement that they can no longer deny coverage to people with pre-existing medical conditions. The vast majority of insurance plans for 2014 must include a list of 10 essential health benefits, some of which, like maternity care, weren’t necessarily included in all health plans a year ago. The law also includes mandatory coverage of mental health and substance-abuse treatment, prescription drugs and rehabilitative care. All preventive care, including annual physicals and routine immunizations like flu shots, must be covered at no cost. Further, insurers are required to take all applicants, regardless of whether they have pre-existing medical issues that may have locked them out of coverage in the past. And they’re prohibited from charging their oldest, sickest members any more than three times as much as their youngest, healthiest members, causing premium prices to rise for many younger people. Costs associated with those mandates are passed along to all members of a health plan. Under the law, most of the estimated 15 million Americans who bought plans individually this year … will have to choose new insurance coverage that meets federal guidelines. …

"The health care law established four broad categories of coverage – platinum, gold, silver and bronze – for which premiums vary based on the amount of out-of-pocket health care expenses consumers are required to pay. Bronze plans have the lowest monthly premiums, but they cover only 60 percent of projected medical costs. Platinum plans have higher premiums but cover 90 percent of medical costs. State officials expect most consumers to select either bronze or silver plans because monthly costs are lower. … The vast majority of the uninsured – an estimated 80 to 90 percent, according to the Congressional Budget Office – who buy coverage on the exchanges will qualify for federal subsidies in the form of tax credits. Those who make up to 400 percent of the federal poverty level (about $46,000 for an individual and $94,200 for a family of four) will be eligible for the subsidies to help offset the cost of premiums. Further, people with incomes up to 250 percent of the federal poverty level (about $28,700 for an individual and $58,900 for a family of four) will qualify for cost-sharing subsidies that will reduce deductibles, in some cases substantially.

"Brokers say they worry most about people who qualify for lower subsidies or none at all. Those with more modest incomes might not have enough in savings to pay for medical expenses. They ‘could get slammed if they get sick,’ said [Karen] Pollitz, [a senior fellow at] the Kaiser Family Foundation. ‘They just won’t have the money. They just won’t.’ A potential consequence could be that some individuals may not seek medical care beyond routine office visits when they should, dissuaded by the specter of having to pay for it out of pocket."

articles.chicagotribune.com/2013-10-13/business/ct…erage

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