Sunday, September 15, 2013
Consumers can choose from nearly 150 plans offered by three companies through the state's new Affordable Care Act "exchange," a website where they can compare plans and prices. The three participating companies list average monthly premiums ranging from $232 to $332, records show.
Enrollment in plans offered under the new law begins Oct. 1 and continues for six months. Coverage starts Jan. 1.
Blue Cross Blue Shield of Oklahoma expects nearly 100,000 currently uninsured Oklahomans to buy its plans, according to the company's rate filings. The state ranks fifth nationally in the number of uninsured residents, with more than 600,000 people lacking health insurance.
Melissa Parchman, an insurance broker who owns Magoon & Associates in Tulsa, said people comparing plans under the new law need to check details such as the list of providers and prescription formularies. Parchman has lobbied in Washington for health-care reform and has created a website explaining details of the Affordable Care Act.
"Consumers should look at any plan they are considering and make sure their doctor is in the network," she said. "The smaller the network, the lower the premium (will be). People need to be very, very careful about that."
Five companiesPlans will be offered through the exchange by five companies: Blue Cross Blue Shield of Oklahoma, Coventry Health and Life Insurance, Aetna Life Insurance, CommunityCare, and GlobalHealth. Two of the companies - Aetna and Coventry - have merged in recent months but plan to offer insurance under both corporate names, according to the state Insurance Department.
The World analyzed hundreds of pages of rate filings that Blue Cross Blue Shield, Coventry and Aetna submitted to the state last week. Those companies plan to offer "preferred provider" plans in the state's insurance exchange.
Rate filings for CommunityCare and GlobalHealth were not released because, as health maintenance organizations, they are not subject to the same disclosure requirements. Rates for HMOs - which use a primary care physician to make referrals to specialists - are generally lower than preferred provider rates.
Parchman said people who have never had insurance before should consider one of the HMO plans.
"You have a primary care doctor who works as a gatekeeper and manages all of your health care for you ... and can guide you to the next doctor if you need a specialist," Parchman said.
Various ratesThe federal government has given grants to several Oklahoma organizations to train "navigators" who will help people enroll in coverage.
The World's analysis focused only on Blue Cross Blue Shield rates because of the differing formats in which companies submitted their rates and because the company insures nearly two-thirds of the state's individual market.
The World analyzed Blue Cross Blue Shield rates in all exchange plans for three scenarios: single nonsmoking adults ages 30, 50 and 64. Families may also buy coverage under the law, and prices for children are far lower than those for adults.
The rate filings do not include federal subsidies available under the law, which could dramatically lower the cost for many people. For example, a 30-year-old nonsmoker making the state's median income would pay less than half of the annual premium for a policy after subsidies are applied, or about $121 per month.
Individuals making up to $45,960 per year and families with incomes of $94,200 can qualify for a subsidy to purchase insurance under the law if their employers do not offer affordable insurance.
In the exchanges, plans are generally grouped under four categories: platinum, gold, silver and bronze.
People purchasing the silver plan, which pays about 70 percent of health-care costs, may qualify for reduced co-pays and other cost sharing in addition to premium discounts if they make $28,725 or less per year.
Companies offering coverage under the new law must offer certain "essential health benefits" and cannot turn away people due to pre-existing conditions.
People younger than 30 and those with low incomes may also qualify for a "catastrophic" coverage plan.
Blue Cross' lowest rate in the World's analysis was $108 a month for a 30-year-old in the Comanche County area choosing the bronze plan, which pays about 60 percent of health-care costs. The company's highest rate was $807 a month for a 64-year-old living in the Oklahoma County area choosing a gold plan, which pays about 80 percent of health-care costs.
The highest average rates for all plans the company filed under the new law were in the Tulsa area. Thirty-year-olds in the Tulsa area would pay an average of $211 per month, and 64-year-olds would pay an average of $559 per month.
The lowest average rates for Blue Cross Blue Shield plans were in the Comanche County area.
Companies consider mortality rates when setting insurance rates for a particular area. The uninsured population has a higher risk and higher mortality rate than those who currently have insurance, the rate filings state.
According to the World's analysis, the lowest-cost Blue Cross plan for a 30-year-old in the exchange costs an average of $143 per month. The same bronze plan would average $225 for a 50-year-old and $378 for a 64-year-old. The figures do not include subsidies.
Educating OklahomansBlue Cross Blue Shield's filing estimates that of the 624,000 people lacking health insurance in Oklahoma, about 224,000 of those will purchase coverage through the exchange.
That figure excludes illegal immigrants and people with incomes too high to qualify for subsidies and assumes that about 60 percent of the remaining uninsured population will buy coverage through the exchange.
The law contains an "individual mandate" requiring people to have health insurance or pay a fine unless they fall into an excluded category.
The fine for an individual begins at $95 next year and escalates to $695 in 2016 but could be higher depending on household income.
People may have insurance through their employer or have coverage through programs such as Medicare, Medicaid, tribal health care or a military plan in order to comply with the mandate.
In an email statement to the World, Blue Cross Blue Shield of Oklahoma spokeswoman Ashley Hudgeons said the company will be working to help educate people about the new health-care law.
"We understand health insurance can be confusing at times, and that is why we strive to provide the best service to our current and potential members to help them make the best health-care decisions for themselves and their families," Hudgeons said.
The company and others planning to offer coverage under the law have stepped up publicity in recent weeks, with mall kiosks, their own websites and booths at community events.
Frank Stone, chief actuary at the state Insurance Department, said the agency talked with companies planning to offer coverage under the new law about how the new rates compare to current individual market rates. Stone said that is how the agency came up with its estimate of increases ranging from 30 percent to 100 percent.
But those estimates do not take into account the subsidies that will be available under the law or expanded benefits due to the law's requirements. Health policy groups including the Henry J. Kaiser Family Foundation of California and Washington, D.C., have cautioned against comparing current rates to rates offered under the new law because of the subsidies and differences in plans.
ConcernsMike Rhoads, Oklahoma's deputy commissioner of life and health insurance, said the law will offer some uninsured Oklahomans a chance to buy health insurance for the first time.
"Whether or not it's affordable remains to be seen," Rhoads said. "At the end of the day, even at a maximum subsidy, everybody has to pay a premium. So at $50 a month, if that's what it's going to cost them, is $600 a year still affordable?"
Insurance Commissioner John Doak and other state officials have been highly critical of the sweeping federal health-care-reform law. Attorney General Scott Pruitt is suing the federal government, claiming that Oklahoma and other states that did not create their own exchanges - which were imposed on them by the federal government - are exempt from the law.
Because the state rejected an expansion of Medicaid, thousands of low-income Oklahomans will not qualify to buy subsidized insurance under the new law. A one-year extension of Insure Oklahoma allows about 30,000 people to maintain coverage through that program, but it is capped at 35,000 people.
Jonathan Small, fiscal policy director for the conservative policy group Oklahoma Council of Public Affairs, said the law has "serious flaws" that will lead to higher health insurance rates.
"A credit or subsidy doesn't lower the cost of an item or product. ... This makes our three-party health-care system worse by introducing a fourth party and even masking costs."
The subsidies are paid by taxes and fees on insurance policies, including nearly 5 percent of the premium for a high-risk pool and administrative costs.
"The problem is, it's insurance, and we've forgotten that insurance is supposed to be an exchange of potential risk for a dollar amount in the hopes from both parties that risk never happens," Small said.
Rate detailsRate filings were released last week for three companies seeking to offer coverage on the Affordable Care Act exchange website in Oklahoma. The companies and two others - CommunityCare and GlobalHealth - are expected to offer plans through the new health-care law.
Because health maintenance organizations, or HMOs, are not required to publicly disclose such filings, rate information for CommunityCare and GlobalHealth has not yet been made public.
Below are selected details taken from the filings. Average premiums will differ according to geographic area, age, smoking status and percentage of health-care costs paid by the plan. Some rates include plans offered outside the exchange.
Blue Cross Blue Shield of Oklahoma
Average monthly premium: $232
Expected 2014 premiums earned: $466.7 million
Expected 2014 claims: $435.1 million
Aetna Life Insurance Co.
Average monthly premium: $332
Expected 2014 premiums earned: $3.3 million
Expected 2014 claims filed: $2.4 million
Coventry Health and Life Insurance Co.:
Average monthly premium: $312
Expected 2014 total premiums earned: $2 million
Expected 2014 total claims filed: $1.6 million
Ziva Branstetter 918-581-8306
Original Print Headline: Oklahomans' insurance rates to vary