Page 25 - Kiplinger's Personal Finance - November 2018

MONEY SPECIAL REPORT

When shopping for coverage, he
Filling the Gaps looked not only at the premiums but
also at the deductibles, co-payments
What States Are Doing and the insurer. A few plans with
lower premiums were with companies
As the federal government rolls back sections of the Affordable Care Act, the type of he didn’t know and had much higher
coverage you can buy and how much it will cost are increasingly determined by where deductibles and co-payments.
you live. Some states have introduced legislation to bolster their insurance marketplace, Volpe picked a silver plan because
while others have embraced Congress’s moves to weaken the ACA. For a better sense of of the balance between cost and
the trends playing out around the country, consider how the health insurance market- coverage. He has to use a limited
place is changing in these four states. provider network with Kaiser, but
he doesn’t go the doctor much, and
California. The state has worked the individual marketplace for 2019. Med- he had Kaiser insurance when he
with insurers to maintain as much ica continues to offer individual coverage was a kid, so he was used to it. “It’s
stability in its individual health and will expand its coverage to include a in the building I went to when grow-
insurance marketplace as possible, says broader network of health care providers. ing up,” he says.
Rabah Kamal, a policy analyst with the Premiums, after increasing 57% last year, There’s an added bonus for picking
Kaiser Family Foundation. State lawmak- are expected to remain flat or decrease a silver plan if you earn less than 250%
ers are currently considering a bill to limit up to 5%. of the federal poverty level ($30,350
the sale of short-term insurance policies for singles, $41,150 for a couple and
and association health plans that lack ro- Minnesota. After large rate de- $62,750 for a family of four). Below
bust consumer protections. Blue Shield of creases in 2018, people who buy that income level, you qualify for an
California and Kaiser Permanente control health insurance from the state’s additional “cost-sharing subsidy,”
the largest slice of the market, but most individual marketplace will likely see pre- which helps reduce your deductible
shoppers have other options, with 11 com- miums fall an additional 3% to 12% for and co-payments—but only for silver
panies selling policies on the exchange. 2019. What’s driving the decrease? The policies. The cost-sharing “might drop
Still, people in some rural areas of north- state’s reinsurance program, which pays the deductible to $200 per year, more
ern California have a slimmer menu—or insurers who sell plans to people with high like a gold or platinum policy,” says
in some cases, a single plan. Premiums for medical costs. But that program is sched- Karen Pollitz, senior fellow with the
policies on the exchange are expected to uled to expire at the end of 2019, which Kaiser Family Foundation. The typi-
rise by less than 9% on average for 2019. would cause rates to spike again. All four cal silver plan has a deductible of
of the state’s carriers that sell insurance about $3,500 per person, she says.
Iowa. The Hawkeye State has on the exchange primarily offer narrow- Even though the federal govern-
used changes at the federal network plans, but two companies, UCare ment stopped reimbursing insurers
level as an opportunity to weaken the and Medica, have plans with a broader for providing this cost-sharing sub-
ACA and deregulate its individual health network of providers. sidy, insurers are still required to offer
insurance marketplace, says Sabrina it to consumers. As a result, many in-
Corlette, research professor at the George- New Jersey. Before the Affordable surers increased their premiums for
town University Center on Health Insur- Care Act, New Jersey had among silver-level policies a lot more than
ance Reforms. The state has given the the most robust insurance regula- they did for the other levels in 2018
green light to a controversial Iowa Farm tions in the country, but the state largely and are expected to do so again in
Bureau Federation plan to sell policies rejected the ACA in recent years, says Cor- 2019. But higher silver premiums
that don’t comply with ACA regulations. lette. Now, with a new governor at the mean that policyholders get a larger
The plans offer limited benefits, do not helm, the state has added a state-level subsidy, so most people getting a
meet benchmarks required by the ACA, mandate requiring residents to have subsidy haven’t been affected by the
and can deny coverage to people with health insurance or pay a penalty (after increase. The size of the subsidy is
preexisting conditions or charge premiums the penalty to enforce the individual insur- based on the silver plan premiums,
based on a person’s health. ance mandate was repealed at the federal but you can use the subsidy on any
Those who buy their own health insur- level). In 2019, the state will charge resi- type of plan. “It significantly increased
ance in Iowa will have three choices of car- dents without health insurance 2.5% of the number of people who were eligi-
riers for 2019, after having only one option their annual household income, or a per- ble for zero-premium bronze plans,”
this year. After sitting out 2018, WellMark person fee of up to $2,085, whichever is says Pollitz.
Blue Cross and Blue Shield will return to higher. KAITLIN PITSKER
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