WASHINGTON — The Obama administration on Friday unveiled data showing that many Americans with health insurance
bought under the Affordable Care Act could face substantial price
increases next year — in some cases as much as 20 percent — unless they
switch plans.
The data became available just hours before the health insurance marketplace was to open to buyers seeking insurance for 2015.
An
analysis of the data by The New York Times suggests that although
consumers will often be able to find new health plans with prices
comparable to those they now pay, the situation varies greatly from
state to state and even among counties in the same state.
“Consumers
should shop around,” said Marilyn B. Tavenner, administrator of the
Centers for Medicare and Medicaid Services, which runs the federal
insurance exchange serving three dozen states. “With new options
available this year, they’re likely to find a better deal.” She asserted
that the data showed that “the Affordable Care Act is working.”
Interactive Graphic
Where Federal Health Exchange Rates Will Rise
A map of upcoming changes in federal health exchange rates.
But Republicans quickly pounced on the data as evidence of the opposite.
“Last
year, many who liked their plan were surprised to learn they couldn’t
keep it,” said Senator Orrin G. Hatch of Utah, who is in line to become
chairman of the Senate Finance Committee. “This year, many who like
their plan will likely have to pay more to keep it.”
The
new data means that many of the seven million people who have bought
insurance through federal and state exchanges will have to change to
different health plans if they want to avoid paying more — an
inconvenience for consumers just becoming accustomed to their coverage.
Share Your Experience With the Affordable Care Act
The Times would like to hear from Americans who
purchased health insurance under the Affordable Care Act.
A new Gallup Poll
suggests that seven in 10 Americans with insurance bought through the
exchanges rate the coverage and the care as excellent or good, and most
were planning to keep it.
In
employer-sponsored health plans, employees tend to stay with the same
insurer from year to year. But for consumers in the public insurance
exchanges, that will often be a mistake, experts said.
Nashville illustrates the need for people with marketplace coverage to look closely at the alternatives available in 2015.
A
40-year-old in Nashville, with the cheapest midlevel, or silver plan,
will pay $220 a month next year, compared to $181 a month this year, for
the same plan.
The
least expensive plan is offered by another insurer, Community Health
Alliance, one of the so-called co-op plans created under the federal
law. It offers coverage for a monthly premium of $194.
But
the lower premium means that consumers will have to pay a much larger
annual deductible, $4,000, rather than $2,000. A policyholder who
becomes seriously ill or has a costly chronic condition could pay
hundreds of dollars in out-of-pocket expenses.
Is the Affordable Care Act Working?
A year after it was fully in place, the Affordable Care
Act has largely succeeded in delivering on President Obama’s main
promises, even as it fell short in some ways and gave birth to a new and
powerful conservative movement.
In
addition, different health plans often have different networks of
doctors and hospitals and cover different drugs, meaning that consumers
who change plans may have to pay more for the same medicines.
Another
problem for consumers is that if the price for a low-cost benchmark
plan in the area has dropped, the amount of federal subsidies provided
by the law could be less, meaning that consumers may have to pay more
unless they switch plans.
The
data, released by the Centers for Medicare and Medicaid Services,
indicates that price increases will be modest for many people willing to
change plans. In a typical county, the price will rise 5 percent for
the cheapest silver plan and 4 percent for the second cheapest.
Affordable Care Act Enrollment FAQs
Answers to common questions about open enrollment and the Affordable Care Act.
Experts
said the wide swings in prices were likely to continue. “Next year will
see another reshuffling,” said Caroline F. Pearson, a vice president of
Avalere Health, a research and consulting company. “Eventually, in a
year or two, we will start to stabilize.”
The
Times analysis found that premiums had increased much more sharply in
places where fewer insurers were competing for customers. Prices for the
lowest-cost silver plan increased by at least 5 percent in 89 percent
of the counties with a single insurer. About a quarter of counties with
one or two insurers saw an increase in rates of more than 10 percent.
The analysis did not calculate how prices might change for people who
keep their plans.
In
2015, as in 2014, large numbers of health plans have high deductibles —
the amount that consumers owe before the insurer starts to pay.
In
Muscogee County, Ga., which includes Columbus, 74 health plans are
available on the federal exchange. Fifty-two of the plans have
deductibles of $2,500 or more, and 27 have deductibles of $5,000 or
more.
The Internal Revenue Service defines a high-deductible plan as one with a deductible of $1,300 or more.
In
Charleston, W.Va., the state capital, only 14 health plans are
available, and all are offered by Highmark Blue Cross and Blue Shield.
Half of the plans have deductibles of $2,500 or more, and one has a
deductible of $5,000 or more.
In
Jeff Davis County in West Texas, 17 plans are available. All but four
have deductibles of $2,500 or more, and seven plans have deductibles of
$5,000 or more. By contrast, Dallas residents have a choice of 64 plans,
and in Houston, 71 are available.
In
releasing the data, administration officials noted that more insurers
had entered the market in many states. By the government’s count, 25
percent more insurers will be participating in the exchange next year,
and consumers will have a choice of 40 different plans, on average, up
from 31 this year.
New
Hampshire shows how consumers may benefit from additional competition.
In most of the state, the number of insurers is increasing to five in
2015, from just one this year. Prices for the lowest-cost silver plan
have fallen by 14 percent.
But there remain large stretches of the country where consumers will still have a limited number of insurers to choose from.
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