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Sebelius said the average consumer will be able to choose among more than 50 plan options. “For millions of Americans, these new options will finally make health insurance work within their budgets,” Sebelius told reporters in a preview call Tuesday. The markets -- called “exchanges” in some states - are the only place where consumers will be able to get a tax credit for health insurance. HHS estimated that about 95 percent of consumers will have two or more insurers to choose from. And the administration says premiums will generally be lower than what congressional budget experts estimated when the legislation was being debated. About onefourth of the insurers participating are new to the individual coverage market, a sign that could be good for competition. But averages can be misleading. When it comes to the new health care law,
Timeline
AFFORDABLE CARE ACT individuals can get dramatically different results based on their particular circumstances. Where you live, the plan you pick, family size, age, tax credits based on your income, and even tobacco use will all impact the bottom line. All those variables could make the system hard to navigate. For example, the average individual premium for a benchmark policy known as the “second-lowest-cost silver plan” ranges from a low of $192 in Minnesota to a high of $516 in Wyoming. That’s the sticker price, before tax credits. In the three states with the highest uninsured population, the benchmark plan will average $373 in California, $305 in Texas, and $328 in Florida. Differences between states can be due to the number of insurers competing and other factors. “One surprise is Texas,” said Larry Levitt of the Kaiser Family Foundation. “That is a state that has put up roadblocks to implementation, but the premiums there are below average.” The second-lowest-cost silfor women as a preventive service, free of charge. The coverage became available in 2013, as lawsuits proliferated from groups and businesses objecting on religious grounds.
ver plan is important because tax credits are keyed to its cost in local areas. But consumers don’t have to take silver. They can pick from four levels of coverage, from bronze to platinum. All the plans cover the same benefits and cap annual out-of-pocket expenses at $6,350 for an individual, $12,700 for families. The big difference is cost sharing through annual deductibles and copayments. Bronze covers 60 percent of expected costs; silver, 70 percent, on up to platinum at 90 percent. Bronze plans have the lowest premiums and the highest cost sharing. As the Avalere study showed, premiums aren’t the only factor consumers should weigh. The flurry of new reports comes as the White House swings into full campaign mode to promote the benefits of the Affordable Care Act to a skeptical public. Republicans, meanwhile, refuse to abandon their quest to derail “Obamacare.”
their determination to repeal “Obamacare.” Former Massachusetts Gov. Mitt Romney, whose Continued from 5 state health law was seen as a model for Obama’s, poor. Enacted later, the fix says he’d sign an executive saved an estimated $13 order on Day One of his billion over 10 years. Oct. 14, 2011 — Sebelius presidency granting a Summer 2011 — Seniors pulls the plug on the ACA’s waiver to all 50 states. long-term care insurance hitting Medicare’s preprogram, because of doubts March 26-28, 2012 — scription drug coverage gap start getting a 50 per- over its long-term financial Supreme Court holds three solvency. The program was days of oral arguments on cent discount on brand the ACA. The administraname medications, part of a priority of the late the health care law’s grad- Massachusetts Democratic tion’s lawyer fumbles his Sen. Edward M. Kennedy. defense, and opponents ual closing of the “doughfeel momentum breaking nut hole.” In 2011, the typNov. 14, 2011 — The their way. ical senior in the gap Supreme Court announces saved about $600 on bills it will hear the constituJune 28, 2012 — With averaging $1,500. tional challenge to the the unlikely support of Aug. 1, 2011 — Sebelius, ACA, setting the stage for conservative Chief Justice John Roberts, the Supreme on the recommendation of an election-year decision. Court upholds the law’s an expert panel, declares core requirement that that most health plans will Fall/Winter 2011-2012 have to cover birth control — Republican presidential most Americans carry candidates are united in health insurance, ruling
In Brief • HEALTH INSURANCE COSTS: The Obama administration is unveiling premiums and plan choices for 36 states where the federal government is taking the lead to cover uninsured residents. New health insurance markets launch next week. • STICKER PRICES: Premiums for a mid-range benchmark plan will average $328 a month nationally for an individual. That is before tax credits that work like an upfront discount for most consumers. •VARIETY: But averages can be misleading. Consumers will be able to choose from an average of 53 plan options when the new markets open Oct. 1 for people who don’t have health care on the job. Individuals can get dramatically different results based on their circumstances. — Source: AP
that the penalties to enforce it are a tax Congress is authorized to levy. But the court allows states to individually opt out of the Medicaid expansion, which accounts for about half the law’s coverage expansion. Summer 2012 — Employers and consumers receive more than $1 billion in rebates from their insurers, which are required under the ACA to spend at least 80 cents of every premium dollar on medical expenses and quality improvement, or refund the difference.
The Northern Virginia Daily
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mates, eventually will gain coverage through the law. The federal government will pay the full cost of the new coverage from 20142016, then phase down to 90 percent. Twenty-four states plus Washington, D.C., have accepted the expansion, according to AP’s count. Eight states are still considering it. And 18 have rejected it, including Texas and Florida, which have many uninsured residents. Many adults below the poverty level will remain uninsured in the refusing states. A state can change its decision at any time, but the full federal payment for the expansion is only available through 2016. Metal levels — The four levels of coverage available through exchange plans, called bronze, silver, gold, and platinum. Bronze plans feature the lowest monthly premiums, but cover only 60 percent of average costs. Platinum plans have higher
premiums and cover 90 percent of expected costs. Pre-existing condition — An ongoing or past health problem. Currently insurers can use pre-existing conditions to deny or restrict coverage, or charge more. Those practices will be barred by federal law starting Jan. 1, 2014, and insurers will have to accept all applicants. Tax credits — Government health insurance subsidies for individuals will come in the form of tax credits. The money will be paid directly to the consumer’s health plan, to help cover premiums. The subsidies are on a sliding scale based on income. Each year, people will have to “true up” with the IRS to make sure they got the right amount. People who receive too generous a tax credit may owe money back to the government. Tax penalty — The fine levied on individuals who disregard the individual insurance mandate. In 2014 it’s $95 or 1 percent of taxable income.
Speaker John Boehner says in an interview that “Obamacare is the law of the land.” His spokesman quickly adds that the Ohio Republican remains “committed to full repeal.”
simplified forms consumers will use to apply for health insurance and financial assistance to pay their premiums. The first version was criticized as too complicated.
Jan. 1, 2013 — Tax increases to finance the ACA take effect on about 2.5 million households, individuals making more than $200,000 per year and couples over $250,000.
July 2, 2013 — In a surprise, the White House announces a one-year delay — until 2015 — of the law’s requirement that companies with 50 or more workers must provide affordable coverage or pay fines. The administration says it’s trying to iron out burdensome reporting requirements.
Winter/Spring, 2013 — States decide whether they’ll run the new insurance markets and expand their Medicaid programs. The ACA advances mainly Nov. 6, 2012 — Obama is in blue states, while most re-elected to a second Republican-led states conterm, deflating Republican tinue to oppose the law. repeal hopes. April 30, 2013 — Obama Nov. 8, 2012 — House administration unveils
Oct. 1, 2013 — Online insurance markets are scheduled to open in every state. Consumers must sign up by Dec. 15 for coverage to take effect Jan. 1.