Arc Update and Navigating Health Insurance Exchanges
Another big week for The Arc in our advocacy efforts and leading the way is a public
hearing on Wednesday on the closing of the Murray Developmental Center in Centralia.
The hearing is taking place at 4:00 p.m. in the chambers of the City Council.
Today I head to Schaumberg today to meet with Autism Speaks and possible legislative
Tomorrow The Arc’s Public Policy Committee meets to discuss legislative recommendations
submitted by our members for possible consideration.
Excellent commentary from today’s Chicago Tribune on health insurance exchanges.
Navigating health insurance exchanges
The online health insurance exchanges promised by Obamacare promptly opened for
business last week and just as promptly crashed. People seeking to sign up for insurance,
or just peruse plans, waited and waited … and waited.
Eventually, we’re sure, the computer problems will be resolved. But many people will
find that when they can get through, they’re confronted with a bewildering online experience.
They’ll have to sort through dozens of plans from different insurers.
This is a complex decision. Some people may be tempted to throw a dart and pick
one with the lowest premiums, assuming all plans are about the same.
Warning: They’re not.
In recent weeks federal officials touted some of the low premium prices available under
the new exchanges. What they didn’t stress, and what careful consumers will find on the
exchange market site, is that insurers have tamped down prices in some cases by greatly
narrowing the hospitals and doctors available in the coverage network. That means if you
favor a particular hospital, say, the University of Chicago Medical Center, you’ll want to
make sure that your plan covers that hospital and your doctors.
If not, you could be on the hook for much higher medical bills for out-of-network coverage,
even though you have insurance.
Let’s back up for a second. Obamacare sets four levels of coverage: platinum, gold,
silver, bronze. The law requires that every plan provide a basic menu of services, including
maternity care, mental health services, prescription drugs and hospital visits. Insurers can
offer more than that, but they can’t offer less.
The different levels of coverage indicate how you and the insurer will split your health
care costs. In a bronze plan, for instance, you’ll pay 40 percent of the costs and your insurance
will cover 60 percent. You’ll pay 30 percent in a silver plan, 20 percent in a gold plan, 10 percent
in a platinum plan.
In the lower tiers, you’ll generally pay lower premiums but will have higher out-of-pocket costs.
For instance, the deductible — the amount owed for covered services before insurance
kicks in — will be higher when you visit a doctor or go to a hospital.
That doesn’t mean all gold plans — or silver or bronze — are created equal.
The differences within a tier can be huge. Blue Cross and Blue Shield of Illinois, for instance,
offers some customers its Blue PPO Gold plan for 314.19 a month or its Blue Choice Gold PPO
for $234.02. The plans have the same deductible. Same coinsurance. Same copays. So what
accounts for the $80.17 difference in monthly premium? One major factor: The higher-priced
plan has 54 hospitals in its network, including world-class Northwestern Memorial Hospital, and
more than 23,000 doctors. The lower priced plan has 26 hospitals, excluding Northwestern. It
has about 10,000 doctors.
You may find a broader doctor/hospital network in a bronze plan than you find in a gold plan,
depending on the insurer. You will need to check to see if your doctors and preferred hospitals
are covered under the policy you want to choose. Plans also differ in which prescription drugs
are covered and how much you’ll pay for a brand name versus a generic.
Don’t assume anything.
There’s plenty of time to investigate before you decide. You can enroll until Dec.15 for
insurance that begins Jan. 1.
If you find yourself confused, be reassured: You are not alone. Almost all the experts
we’ve talked to — insurance agents, hospital officials, doctors — are still sorting out the
details of this massive health care expansion.
JOSÉ M. OSORIO/TRIBUNE PHOTO
The Affordable Care Act’s exchanges can be confusing, but you have weeks before a
Dec. 15 deadline to figure it out.
Tony Paulauski Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423