Amanda Warren wasn’t sold on Obamacare, even though it helped her gain health insurance for the first time for her young adult daughter, Briana, who has autism.
This year, with a nearly 60 percent increase in her family’s premium for the same policy that the family had last year, Warren said she’s become “the poster child for not-so-good” experiences with the Affordable Care Act’s Health Insurance Marketplace.
“I’ve just had it,” said Warren, 60. “The only thing I can think of is to drop Briana. I feel terrible about it. We’re right back where we started, but paying more.”
Warren might be an extreme example, but many Georgians with Obamacare plans are also seeing double-digit increases for 2016.
Some consumers report having to switch insurance companies to get a comparable rate, while others report deciding to drop coverage altogether. More than 400,000 Georgia residents purchased 2015 health coverage through the marketplace at Healthcare.gov. (The third year of open enrollment ends Jan. 31.)
Still, the national average premium increase for the most popular plans — the second-least expensive plan in the silver category — has increased not much higher than the rate of inflation. The premium for the second lowest silver plan — by far the most popular metal tier — has increased nationally by only about 3 percent, date from the nonprofit Kaiser Family Foundation shows.
“It’s all a big education process,” said Andy Slavitt, acting administrator for the Centers for Medicare and Medicaid Services, which oversees the marketplace, “but it’s a heckuva lot better than ‘I’m not going to go to the doctor because I don’t have insurance.’ ”
Warren’s husband is an artist, and the couple has a 12-year-old, Chloe.
The family thought that Obamacare would bring them help. They could cover Briana, their older daughter, and prices might be lower than what they had paid in the individual market before the health care law.
It didn’t turn out that way.
“It’s not healthcare, it’s greed,” Warren said of the jump in premium for the family’s policy.
Overall, silver plans available in the Atlanta area increased on average 8.8 percent, from about $286 to about $311. Alliant’s premiums for silver plans rose the most — more than 20 percent, from $302 to $363. Cigna’s increase was smallest, with a 2.5 percent increase, rising from $325 to $333.
The health care law provides tax credits for many families and individuals, which help lower the cost of monthly premiums. But the health care plan and rate the credits are based on can change from year to year.
For many consumers, therein lies the rub. To keep a comparably priced plan, they may have to switch plans or insurers.
“If they haven’t gone back in and looked, they could be looking at a big increase,” said Cynthia Cox, associate director of health and private insurers for the Kaiser Family Foundation.
‘A complex purchase’
Marketplace experts echo Cox.
“The truth is, we’re still learning in this area, and the health plans have a lot to learn,” said Andy Slavitt, acting administrator for the Centers for Medicare and Medicaid Services, which oversees the marketplace.
The first thing people consider is the premium — or cost of a policy — and then whether their doctor is in network. They consider deductibles third, Slavitt said.
A better approach might be to view them all in concert, he suggested. Co-pays are also a factor, as are out-of-pocket costs.
“It’s a complex purchase,” said Slavitt.
Kathy Hempstead, director of coverage at the Robert Wood Johnson Foundation, said that Georgia consumers have a wider array of insurance companies and plans to choose from than in other states.
“Consumers in (Georgia) are better off than in a lot of others, and consumers should go back in there and look,” Hempstead said. “But don’t be bedazzled by a premium. Ask how do you use healthcare, what is the cost-sharing.”
Some policies offer as many as three office visits for free, for example, before a person is charged. Others pay for certain drugs before a deductible needs to be met.
‘Premiums are so high’
Cindy Zeldin, executive director of advocacy group Georgians for a Healthy Future, stressed that shopping around is imperative.
“There are an array of plans out there that are affordable,” she said. Zeldin also stressed the importance of contacting an enrollment “assister” or a navigator, people who are specially trained to help consumers compare plans and prices and to offer enrollment assistance.
“And I also want to emphasize that the vast majority of people are eligible for (tax credits),” Zeldin said.
Slavitt with the federal government has stressed that about three-fourths of Georgia consumers who buy marketplace insurance pay about $75 a month. Nearly 90 percent qualify for tax credits to make their plans more affordable.
Those prices and that coverage are for those whose individual income is generally lower than $25,000.
What about the price for a self-employed contractor, or those covering a family and making close to the limit for tax credits, such as the Warren family? A family who isn’t poor but who is nowhere close to rich?
“We can’t afford to go to the doctors because of premiums are so high,” Warren said.