Lincoln Journal Star - Health Insurance Costs Rising Dramatically for ACA Plans

News Article

By Nancy Hicks

Nebraskans looking at individual health insurance plans under the federal Affordable Care Act likely will be shocked at the price increases for next year -- an average 50 percent premium hike.

The actual increase depends on where you live, whether you are a smoker and other factors. But the premiums have gone up significantly, said Martin Swanson, with the Nebraska Department of Insurance.

The premiums for small-group insurance are rising much less, an average 16 percent average, he said during a public forum sponsored by Rep. Jeff Fortenberry on Wednesday.

For example, a silver plan under ACA will cost a 28-year-old about $337 a month in the group market next year, but about $425 in the individual market, said Chris McPike, a vice president of ComPro, a health insurance brokerage company.

A family with two adults and three children will pay about $1,900 a month for an individual plan and less than $1,500 a month under a group plan, she said.

A couple, both 63, who retired early, will pay around $1,000 a month for an individual plan next year, unless they qualify by income for some tax credit subsidy, she said.

"That is the reality of what we are looking at in the individual market," she said.

The higher costs are being driven by several factors. Younger people are not purchasing health insurance, and the people who are are using services at a higher rate than predicted, thus driving up the costs on individual plans, said Swanson.

Insurance companies have found "they are spending about $1.04 for every dollar they take in, and they can't make money on that," he said.

The problem is not going to go away. And the people feeling the pain the most are folks who don't receive a subsidy. They are paying the full freight, Swanson said.

About 89 percent of Nebraskans purchasing insurance on the individual market do receive at least some subsidy.

Fortenberry said he believes health care cost containment will be achieved by consumers with high-deductible plans who look at prices of health care procedures and prescriptions and pressure health insurance companies for lower costs.

For example, people can save money by shopping around for prescriptions, according to Matthew Leonard, director of sales for Blue Cross and Blue Shield of Nebraska.

A prescription may cost $100 at one pharmacy and $210 at another, he said.

With a move to plans with larger deductibles, people are not insulated from the costs as they were when they simply made co-payments, he said.

But a consumer in the audience said getting full information about the costs of a health care procedure is impossible. Jill Jank said there are other charges beyond the basic hospital or doctor charge that the consumer doesn't know about until later.

And even getting basic information is difficult because the insurance company and hospital pass you back and forth. "You get the runaround," she said.

Others at the forum also pointed out that doctors often can't share cost information with patients, and pharmacies can't share details unless they are asked by the consumer.

When ACA, or Obamacare, began three years ago, insurance leaders expected the small group market to dissipate. That first year, the group market did decline as employers dropped coverage, believing their employees would be better off with individual plans and tax subsidies.

But now many small employers are looking at health insurance as part of a benefit package to keep and attract employees, said McPike.

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