Obamacare premiums: What the price leaves out

Checking a patient's blood pressure.

People planning to buy insurance on the exchanges have been waiting for somes clue as to what the policies will cost.

The wait is over. The Obama administration has released a kind of price list for policies that will be sold on the 36 federally run health exchanges, when they open for enrollment on Tuesday. 

Some of the prices are eye-popping. Although the average premium for an individual is $328 a month, a 27-year old in Dallas who makes about $25,000 a year, could buy a lower level bronze plan for $74 a month.

But with insurance, as with many things, the premium is just the beginning.  

“You think you get a really sweet deal on health insurance,” says Georgetown’s Sabrina Corlette.

But the health-policy professor says what looks like a sweet deal, may not be. “The premium is just one dimension of your health insurance cost,” she says.

There are also deductibles -- the amount you pay up front, before your coverage fully kicks in.

And there are co-pays -- the $20 or $30 payments you have each time you see the doctor -- provided, of course, the one you need is in your network. Many of the policies could have fairly limited networks of providers and hospitals. 

“If you need to get specialty care that’s outside of that network, you may have to pay more,” says Corlette.

Prescription costs, which may not be covered, can also be brutal.

“It’s thousands of dollars to a consumer,” says Dan Mendelson, CEO of Avalere Health which released a study today on out-of-pocket costs for policies offered on some of the exchanges.

Mendelson says it’s quite possible people will wind up paying more for medication than for their monthly premiums.

“Our research has shown that patients who face these very high deductibles often abandon their prescriptions at the point of sale,” he says.

Even patients with cancer would skip their medication, says Mendelson, if they have to pay more than $500.

The Affordable Care Act does have annual spending caps of $6,400 for an individual, $12,800 for a family. And most of the policies on the exchange qualify for federal subsidies. But if you can’t afford all the deductibles and co-pays, your insurance might not be worth much, no matter how cheap your monthly premium.

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.
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Like many I was very disappointed in this story and is, unfortunately, a bit typical of how the media is covering the introduction of the ACA Marketplaces. Instead of telling us how much insurance may cost, how about telling the uninsured that the alternative to not having insurance when one gets sick is bankruptcy, or maybe death. Or... list ACA advantages like:

It's insurance just like others that get it have from companies that the insured already deal with and deductables and copays are NORMAL! Of course, single payer would be better...

Insurance companies may not deny coverage to children who have so-called pre-existing conditions, like asthma?

Insurance companies may not deny coverage to adults with so-called pre-existing conditions, like pregnancy?

Insurance companies may not place lifetime caps on health insurance coverage?

Small businesses are eligible for tax credits to help pay for their employees’ health care?

Young adults up to age 26 may stay on their parents’ insurance plans?

Starting October 1st, for the first time, the uninsured can sign up for private insurance that is affordable?

This is a very disappointing piece of reporting and provided zero new insight or even a morsel of new information. Prior commentors have already hit many salient points concerning the broadcast. I would add that reporting a slice of numbers without any context for reference is both misleading and disingenuous. At a minimum I would think marketplace would provide context for a story, such as... today what the 'referenced' individuals are paying for the cited drugs, seeing a physician, specialists, etc? If they are not paying, then who is and what are they getting? Frankly, I am getting tried to hearing the one-sided explanations for both the pro-and cons- of the law. How about marketplace doing something that could be of interest and benefit to many. For example take a couple of prototypical people and using comparative chart(s), appropriately referenced, show what they get today, what is the cost to them or whomever else is paying, and what will be their cost and service under a chosen plan in the exchange. Perhaps a tall order but one that is doable should you care to take on a meaningful and helpful piece of reporting. Commentor "Hopeful' already gave a great start with COBRA. Nothing is ever perfect but at least we can strieve to view this issue as others through the lens of data and intellectual integrity. Thank You.

I, too, found this story frustrating and irritating. It's fair enough to remind people that there's more to the cost than the premium, but I agree with Thebert - it sounded like the intention was NOT an informational piece, but to warn people not to be fooled! We listen to public broadcasting to avoid this very kind of reporting.

In 2011 I was working for a sole proprietor, so he provided an individual policy. The MONTHLY premium was $987, with a $5,000 deductible, and a $40 copay for primary care physician. Prescriptions were $35/55/75/50% copay depending on class of drug. When I lost my job due to office closure, I could not afford the insurance. So I would have loved one of these policies.

A superior title to your piece, rather than, "Obamacare premiums: What the price leaves out" would have been, "Insurance premiums: What the price leaves out"

I'm curious, did someone come to the writer and say, "We want you to kinda, you know, jump on this whole 'Obamacare Bad' bandwagon, and come up with a negative angle here for a story", or has the author simply never bought insurance before?

I'm disappointed. This isn't Marketplace quality work. Let's hope the writer's simply not very rigorous in his chosen craft - the alternate explanation would truly be alarming.

I wish I could print here what I was screaming at the radio alone in my car during this so-called story. What a blatant attempt to denigrate the ACA. Listen, Gorenstein, every single one of us has to deal with this with our employer provided insurance. They offer us multiple plans and you have to weigh all the options of price, deductibles, co-pays, etc. This was dumb "story" really made the reporter out to be a moron who knows nothing about normal life and was only interested in making the ACA out to be something terrible. I guarantee I will be switching my unemployed 22 yr old daughter from my employer provided healthcare to ACA insurance because it will be cheaper and I will be helping my son get insurance since his employer doesn't provide it and he has thousands of dollars in bills for previous emergency room asthma treatments that he will never be able to pay. The ACA is a very good thing and I cannot understand the cruel minds of those who want it to fail.

I don't understand why this is a story. Everyone who has ever had insurance knows that the price is meaningless without knowing the details of the plan: deductibles, copays, out-of-pocket expenses, etc. "Our research has shown that patients who face these very high deductibles often abandon their prescriptions at the point of sale,” he says." This is true of ANY insurance in the U.S. A simple phone call to the 800# provided on the Obamacare website (24 hours/day plus chat 24/hours/day) would inform one that the full details of the plans will be available on October 1. I think this is very reasonable. There is a LOT of general information on the website, and available through customer service. The very reasonable answer they gave me when I called last week was, the details that go with the full plan with prices were still being firmed up. As I said, there's no reason for anyone to be completely ignorant (as I've read so many people say they are), if they take time to read the information on the website or call in or chat. I don't think it's asking too much to wait until October 1. I can guarantee that mine is going to be better in price and coverage than: (1 what we're paying for COBRA right now, and (2 the fact that my husband will not be able to get ANY insurance other than Obamacare when COBRA runs out since he's had a heart attack. Why is everyone seemingly so eager to poke holes in something that may be very helpful before we even know??


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