Editorial: An unwelcome tradeoff

  • Posted: Tuesday, October 8, 2013 12:51 a.m.

Although President Obama repeatedly said consumers could keep the insurance they already have under the Affordable Care Act, that comes with a major disclaimer. You can keep existing coverage — providing it meets the new ACA standards.

Some existing lower-cost policies don’t, as many North Carolinians who purchase insurance individually are now discovering. Blue Cross and Blue Shield and other carriers are notifying some customers that they will need to switch to a comparable — but upgraded — policy that may carry significantly higher “retail” costs.

Many of those affected have opted for policies that offered higher deductibles and more limited coverage in exchange for low premiums. Such policies, sometimes loosely called “catastrophic coverage” plans, could make sense for individuals or families who needed to purchase their own coverage, could stomach a deductible of $10,000 or more and didn’t anticipate having major medical bills.

Now, however, such bare-bones policies don’t meet the benefit requirements of the ACA except for younger Americans and special hardship cases. The ACA does offer four levels of coverage — from bronze to platinum — but the rules cap deductible plus out-of-pocket costs at $6,350 for an individual or $12,700 for a family. While the policies offer different levels of deductibles and co-pays, all must also meet the ACA’s minimum “essential health benefits,” which include pregnancy coverage and preventive-care services like physical exams. The coverage is more comprehensive — but that’s not a welcome tradeoff for people who may be looking at a potential quadrupling of their premiums.

However, in an article in the Charlotte Observer, Adam Linker, a policy analyst at the North Carolina Health Access Coalition, suggests the letters may be causing undue alarm. “What people need to do is ignore the price that’s on those letters,” Linker said. “That’s just Blue Cross trying to guess at what may be a comparable plan.”

Many of those notified may find they qualify for a subsidy if they buy a policy through the the state’s exchange, or online marketplace. The sliding-scale subsidies are tax credits available to individuals and families whose income is within 400 percent of the federal poverty level ($45,960 for an individual, $62,040 for a family of two and $94,200 for a family of four). But even here, there are complications — the exchanges have had technical snags, and in North Carolina, only two insurers are participaing in the exchange.

For those receiving these notifications, the estimates for a comparable substitute policy can be a rude surprise. But before panicking, consumers should go to the online exchanges (the technical glitches are being resolved), compare coverage options and get firm figures on what their actual premiums will be.

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