The online health insurance marketplaces that debuted this week are key to enrolling millions of uninsured Americans for subsidized coverage under the Affordable Care Act, though technical problems with the website HealthCare.gov caused a log jam that locked out many.
Once inside, though, South Florida consumers will find a dizzying array of competing plans that vary significantly in price and benefits — and that could leave some paying low monthly rates, but risking high out-of-pocket costs for medical care.
Across the country, insurers took different approaches to health insurance plan types, with some offering high-deductible catastrophic coverage and health savings accounts with low monthly payments that are expected to be popular with younger consumers, but most sticking to traditional HMO and PPO plans with higher monthly premiums but more value.
Prices and availability varied significantly, according to an analysis of the 1,923 plans being sold in the 34 states where the Department of Health and Human Services is running the marketplaces or working in partnership with states.
Under the health law, insurers can only set prices for policies that begin in 2014 according to age, household makeup, geographic location and smoking status (insurers are allowed to charge smokers 50 percent higher premiums than nonsmokers).
Consumers in Miami-Dade and Broward can choose from plans offered by nine insurers, with premiums slightly lower in Broward than in Miami-Dade.
There are 141 health plans on the exchange in Miami-Dade and 136 in Broward, with prices for a 27-year-old individual ranging from a low of $85.81 a month for catastrophic coverage in Broward to a high of $420.16 a month for a premier managed care plan in Miami-Dade. The same premier plan in Miami-Dade costs $716.03 a month for a 50-year-old individual and $1,419.22 a month for a family.
With subsidies, however, eligible low- and middle-income individuals and families that earn up to four times the federal poverty level ($46,000 for an individual and $94,000 for a family of four in 2013) can lower their monthly costs even more.
But monthly premiums are only part of the equation that consumers should consider when comparing plans. Ray Smithberger, general manager of individual and family plans for Cigna, urged consumers to consider the “total value” of their coverage, including provider networks, when shopping for plans that can cost a family as much as in one year as a mid-size sedan, or $20,000, when accounting for monthly premiums and out-of-pocket costs, such as co-pays and deductibles.
Smithberger said consumers should study their options. He cautioned consumers motivated by low monthly payments to consider the potential risks of higher out-of-pocket expenses for medical care — when a plan with a higher monthly premium might offer greater coverage of costs.
“If they’re thinking, ‘I’m getting my insurance and I’m only spending, with my subsidy, $25 a month’,’’ he said, “they need to understand that if they have a broken leg or need to go to the ER, that’s going to cost them out of pocket.’’
Insurers also offer plans with lower monthly payments but with narrow provider networks that restrict consumers’ choices of doctors and hospitals.
Cigna is offering only PPO plans on the exchange in Miami-Dade and Broward. Smithberger said the network of primary care physicians, specialists and hospitals for exchange plans will be the same as the network used by the company’s off-exchange plans, including employer-provided coverage.