Let’s talk price today. Not subsidies, which will help most uninsured in Allen County, but plain unvarnished costs. What do Marketplace policies cost? What factors determine that cost?
The Marketplace offers Allen County residents 36 different products by two different insurance companies. These products range from $102 per month to $918. This huge disparity results from very different coverage offered to very different people.
The $102 buys a Catastrophic policy for a 22-year-old in Allen County who does not use tobacco. Catastrophic policies have high deductibles and co-pays. They are made available only for those under 30 or who can show that other policies would be a financial hardship.
The $918 is for a 64-year-old living in Allen County who uses tobacco purchasing a Platinum policy. Platinum policies offer the best coverage with the lowest deductibles and co-pays. Platinum policies cover 90 percent of all medical costs.
Policy prices on the Market are determined by four factors.
1) Coverage;
2) Age;
3) Location, and
4) Tobacco use.
Other factors like gender, pregnancy, health history or pre-existing conditions cannot be considered.
Let’s consider each of these factors which contribute to setting a policy price:
Coverage
In order to help consumers make informed decisions about policy choice, the Marketplace requires policies to be classified into five groups: Catastrophic, Bronze, Silver, Gold and Platinum. As we already discussed, Catastrophic policies offer the lowest levels of coverage. They are appropriate for someone at lowest risk, like a very young healthy person or a person who cannot afford better coverage. Overall, they pay about 50 percent of all medical costs incurred. Like all Marketplace policies, they cap total out-of-pocket costs of an individual at no more than $6,350 per year. This is a significant loss, but it still protects many from life-long financial ruin or bankruptcy.
The “metal” policies — Bronze, Silver, Gold and Platinum — have progressively lower premiums and co-pays. Bronze covers 60 percent of all medical costs, Silver 70 percent, Gold 80 percent and Platinum 90 percent. The Platinum plan above has a $0 deductible, 50 percent co-insurance on doctor visits, and a maximum annual out-of-pocket of $1,150.
Location
