NAPLES — Uninsured residents in Collier County may fare better than those in Lee County with lower premiums when they buy insurance under the Affordable Care Act, data released Wednesday shows.
The U.S. Department of Health and Human Services has county-by-county policy rate data available for the 36 states in which the federal government is in charge of establishing online marketplaces for the uninsured to select plans.
Except for the very low-income who are uninsured, all others who are uninsured must comply with the “individual mandate” that they buy insurance if they don’t have employer-sponsored coverage. The coverage must be in effect Jan. 1.
The rates are for four tiers of plans, which differ based on how much of the costs that the individual will pay and how much is covered by the plan. There also are “catastrophic” plans for people under 30.
What wasn’t disclosed with the rate data Wednesday was which insurers are tied to which rates, but Collier will be served by Florida Blue and its Health Options subsidiary — that’s the same for Lee County except for the addition of Cigna, a recent report from the Florida Office of Insurance Regulation shows.
Premium rates appear lowest in Texas and Florida, two states where legislatures fought hard against the Affordable Care Act, or Obamacare, according to an analysis by the Kaiser Family Foundation.
The new federal information says there will be 77 health insurance plans in Collier and 62 plans in Lee, which is an increase from numbers shown in an earlier state report.
The online marketplaces for the uninsured to buy coverage is for individuals and families with incomes from 100 percent of the federal poverty level to 400 percent. That’s between $11,500 to $46,000 a year for an individual, or up to $94,000 for a family of four.
Florida counties will have an average premium under a “bronze plan” of $257, before any subsidies, according to the federal government.
With a “bronze plan,” the insurance will cover 60 percent of health care costs, while the person enrolled is responsible for paying the remaining 40 percent. The bronze plan has the least generous coverage and more out-of-pocket costs, so consumers will have lower monthly premiums.
In Collier, a single person who is 35 could have a monthly premium of $221 with the lowest-cost bronze plan, before factoring in the subsidy that is based on income, the data shows. In Lee, a 35-year-old would pay $249 monthly for the same plan, before a federal subsidy to help defray the expense.
For a 45-year-old, the premium using the lowest-cost “silver plan” in Collier would be $291 monthly before a subsidy, while it would be $328 monthly in Lee County. With “silver plans, the insurance covers 70 percent of the costs while the person enrolled is responsible for 30 percent of the costs.
Under the “gold” and “platinum” plans, the average individual will pay 20 percent and 10 percent, respectively, out of their pocket for covered benefits.
Besides calculating the premiums and subsidies, consumers also have to consider annual deductibles before choosing a plan. Gender isn’t a factor in rates and nobody can be denied coverage due to pre-existing conditions. Subsidies are based on family income and size, where the insured pays between 2 percent and 9.5 percent of income for premiums.
All the plans must offer “essential health benefits,” including emergency services, mental health and substance use disorders, prescriptions, rehabilitative services, maternity and newborn care, laboratory services, wellness and chronic disease management, and pediatric care.
An exception is catastrophic-only coverage, which will be available to people under 30 and to some people with very low incomes.
Health insurance rates in Lee have been higher in Collier for several years, so it’s not surprising it will be that way with the online marketplace rates, said Matt Dinkel, a health and benefits professional with the independent firm Alan Williams & Associates in Fort Myers.
Dinkel said the marketplace premium rates are higher than what someone can get in the general insurance market, but because there are federal income-based subsidies involved in Obamacare, in the end the cost is lower.
“They will be more affordable because it is based on income,” he said. “It’s going to create a place for more affordable plans.”
The marketplace plans and subsidies are especially helpful for older people whose incomes may be lower, because the subsidies are higher with the less income someone receives, he said.
Wayne Sakamoto, president of Health Insurance Interactive in Naples, said the number of plans that will be available in Collier is great. However, he warned that with a low-cost plan, there will be restrictions on which doctors and medical centers are available.
“Even with national carriers, most of them compete with limited networks,” Sakamoto said.
Still, he points out that the online marketplaces are directed at people who have been uninsured and whose options for health care often are limited to expensive hospital emergency rooms.
“The other group who will benefit from this are the uninsurable, those people with pre-existing conditions,” he said. “They will be the first to (sign up). There would be the woodwork effect — a lot of people will be coming out of the woodwork. It may be the first time these people will have insurance.”
Collier health insurance premiums
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