Healthcare

Obamacare plans for South Florida vary widely in prices, value

 

dchang@MiamiHerald.com

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.

“That’s how we designed our product offering,’’ he said. “We kept it relatively simple.’’

Molina Healthcare executives also stuck with the simple and familiar.

The insurer specializes in delivering healthcare to low-income consumers, particularly those who use Medicaid, the state-federal insurance program for the poor and disabled. Molina has about 1.8 million customers nationwide and created plans to sell on the individual market in nine states, including Florida, said Mario Molina, a physician and chief executive of Molina Healthcare, which his father founded in the 1980s.

The insurer has about 81,000 members in Florida’s Medicaid managed care program but has no experience selling individual health plans anywhere in the country. It is offering three HMO plans each in Miami-Dade and Broward.

Molina said he hopes to leverage the company’s experience serving low-income clients and its familiarity with what he called “a culture of poverty.’’ Molina believes many of the consumers who will buy subsidized plans on the exchange will have similar needs and habits as Medicaid clients.

“The strategy is really to dovetail with our Medicaid business,’’ he said. “Medicaid is essentially an individual market for low-income patients ... and Medicaid has premiums that are paid for by the state. The reason we went after the exchange is we feel there are a lot of similarities.’’

He said the two issues that matter most to low-income consumers are their relationship with their primary doctor and out-of-pocket costs. Transportation also is key. The company has built its clinics in other states near bus stops or light-rail systems.

Among the doctors and clinics in Molina’s provider network for South Florida are federally qualified health centers that see large numbers of low-income and uninsured clients.

The insurer has a large presence in California and Washington, Molina said, but company executives are still learning about South Florida — a knowledge gap that they bridged with cost estimates calculated by actuaries.

“Everything is an estimate,’’ Molina said. “We’re making estimates about what these patients look like, what services they need, how often they’re going to see a doctor, how often they’re going to be in the hospital, what their drug costs are likely to be.’’

While insurers such as Molina are eager to learn more about South Florida, consumers have been overwhelming the online marketplace at HealthCare.gov in the past week, causing delays or shutting out visitors altogether.

HHS officials reported Friday that they would take down the application portion of HealthCare.gov during “off peak hours” over the weekend to allow more simultaneous users to create an account and move through the application and shopping process.

HHS spokeswoman Joanne Peters reported that HealthCare.gov received 8.6 million unique visitors in the first three days, while the call center handled 406,000 calls and web operators received 225,000 requests for online chats.

Peters said HHS added more technicians and trained representatives to handle calls to the marketplace’s toll free number, 800-318-2596.

Florida insurers confirmed that some consumers had successfully used the exchange to enroll for health plans in the first few days after the Oct. 1 launch, though none would say exactly how many. Some hinted at additional technical difficulties between their computer systems and the federal government’s.

Paul Kluding, a spokesman for Florida Blue, issued a statement in response to the Herald’s questions about how many individuals had successfully enrolled for subsidized plans with the insurer using the federal exchange.

“Florida Blue has received an initial batch of insurance applications through the marketplace,’’ Kluding said. “Each application must be verified, and that process is underway. The marketplace is open and the application process is functioning. Meantime, Florida Blue is working with the federal government on technical aspects that will expedite and improve the process for consumers.’’

It’s unclear what “technical aspects,’’ Kluding was referring to, but one way in which private insurers and the federal government will need to communicate will be to transfer payments for premium subsidies, which will be paid directly by the government to the insurer without ever touching consumers’ hands.

Cigna’s Smithberger said the insurer had tempered expectations for the system during the first few weeks of enrollment, which runs through March 31. For coverage to begin on Jan. 1, though, consumers must purchase a plan by Dec. 15.

“We did not expect everything to happen smoothly. This is a very big lift for the entire industry,’’ said Smithberger, who confirmed that Cigna had received applications from Florida consumers using the federal exchange.

“I’d characterize it as a trickle,’’ he said of the enrollment numbers, “rather than a wave.’’

Insurers such as Cigna said they will need time to assess the products they’ve created for South Florida.

“This is such a new market,’’ Smithberger said, “that we have theories of what we think people will purchase, but it’s going to be several months before we see if that becomes a reality.’’

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