Q: Why were
approved rates for some companies higher than the companies asked for?
A: Two insurers, Aetna and United,
announced earlier this year they were pulling out of the federal health care
exchange and wouldn’t be selling individual health plans in Pennsylvania
through the healthcare.gov website. This
created a great deal of uncertainty among the remaining insurers participating
in the federal healthcare exchange in Pennsylvania.
these insurers were concerned about getting many more customers who had been
with Aetna or United previously, and were concerned some of these customers
would be very sick and have high health care bills the insurer would have to
pay. Therefore, it was difficult for
these insurers to know how to price their plans for 2017.
order to make sure all Pennsylvanians had an opportunity to buy individual
health plans on the healthcare.gov website, the only place where people can get
a health plan and qualify for subsidies to help pay premiums and in some cases
other out-of-pocket expenses, we needed to approve rates for insurers that
would keep them in the Pennsylvania market, by allowing them to cover projected
costs with new customers.
average approved rate increase is 32.5 percent.
That’s a very high increase. Do
you really think people can afford this kind of increase?
A: Most people buying individual health
plans in Pennsylvania won’t pay anything near a 32.5 percent increase. One reason is that currently, 78 percent of
people with individual health plans get subsidies to help pay their premiums,
and in some cases depending on their income, deductibles and other
out-of-pocket expenses, too. Generally,
as premiums rise, subsidies will rise, too.
federal government estimates 75 percent of Pennsylvanians who buy individual
health plans through the federal exchange at healthcare.gov, will pay less than
$100 a month in premiums for 2017.
eligible for a subsidy, an individual can have an income up to $47,480, and a
family of four can have an income up to $97,200.
addition, in some parts of Pennsylvania, some insurers are offering plans “off
exchange”, or sold by agents or directly from the company, and not through the
healthcare.gov website, that have lower premiums than on exchange plans. If a consumer does not qualify for a subsidy,
one of these off exchange plans may be a better deal, so consumers should check
into this option.
of plans by county is on the Insurance Department website, www.insurance.pa.gov, on the Health
page, under Approved 2017 ACA Rates by Rating Area, near the bottom of the
page. The link says 2017 Individual
Market Plans by County.
Q: Where can
people find the plans available where they live, and is there help for people
trying to figure out what plan is best for them?
A: For plans on the federal exchange,
people can go to www.healthcare.gov
. This lists on exchange plans available
in a given area. Only plans sold through
the healthcare.gov site are eligible for subsidies.
individual plans available in a county are listed at www.insurance.pa.gov, under Approved
2017 ACA Rates by Rating Area, at the bottom of the page. This lists both on and off exchange plans.
called navigators are available to help consumers sift through available
plans. A list of navigators in
Pennsylvania by county is on the Insurance Department website’s Health page,
near the bottom at this bullet: If you are a
consumer looking for a health insurance navigator, click here.
agents may also be able to help find the right coverage.
Q: What should
I look for when shopping for a health insurance plan?
A: Premiums aren’t the only cost
with a health insurance plan. Plans also
have other out-of-pocket costs—deductibles, co-pays, and so on. Generally, plans with higher monthly premiums
have lower deductibles and other out-of-pocket costs.
Something else very
important to consider is the list of doctors and other health care providers
that are in a given insurance plan’s network.
Each insurance company has a list on the website for each health plan it
offers, called a provider directory, of what doctors and other health care
professionals are in that insurer’s network.
Using an in-network
provider lowers consumers’ costs—when a provider agrees to be in an insurer’s
network, they agree to accept the insurance payment for services, so consumers
owe less out-of-pocket.
Insurers also have
a list of prescription drugs that are covered—this list is called a
formulary. If you take prescriptions you
will also want to look at this list.
Q: Are there
ways I can get help shopping for health insurance?
A: The Insurance Department has a few
short videos, each about four to five minutes in length, to help consumers shop
for coverage. These are on the Insurance
Department’s website, on the Health page.