It's supposed to be simpler; but, an apples to apples comparison of premium costs projected under the Affordable Care Act is freighted with mitigating and aggravating factors, as exemplified in a report by the U.S. Department of Health and Human Services.
As Arkansans began to explore the Health Insurance Marketplace designed under the federal health insurance plan which opened Tuesday, the HHS' own report on the program required 36 separate footnotes over a 15-page document to explain how premium costs compare state to state.
“Plan data is in final stages, but is still under review as of September 18 and may be revised in HHS systems before being displayed for consumers, so this information is subject to change,” the report states.
Eligibility is open to all U.S. citizens or “legal residents” who are not incarcerated, according to the report.
“In addition, individuals and families with household incomes between 100 percent and 400 percent of the Federal Poverty Level wo are not eligible for certain other types of coverage may qualify for tax credits to make premiums more affordable,” the report states, before adding in a footnote, “Tax credit eligibility is dependent on several factors in addition to income, including whether an individual is eligible for Minimum Essential Coverage through their employer, Medicaid, or CHIP.”
Essentially, the report explains that individual and family choices under the ACA will be based upon a variety of bronze, silver, gold and platinum plans, as well as catastrophic coverage plans for young adults and “those without affordable options.”
Those plans are based upon “actuarial value,” which the footnotes define as “a measure of health plan generosity.”
“A bronze plan has an actuarial value of approximately 60 percent, a silver plan has an actuarial value of approximately 70 percent, a gold plan has an actuarial value of approximately 80 percent, and a platinum plan has an actuarial value of approximately 90 percent,” the report states.
The plans pay from a low of 60 percent to a high of 90 percent of eligible healthcare costs; the first mitigating or aggravating factor, depending upon an individual's current level of insurance coverage.
Availability of plan varieties depends upon the choices offered in an individual's state and the “rating area” in which his or her community falls within the region covered under the rating area.
“An enrollee may have fewer issuers participating in is or her rating area than the total number participating in that state, because issuers are not required to offer a qualified health plan in every rating area,” according to Footnote 9 in the report.
In addressing a comparison of the weighted average premium costs nationally, the report only compares them partially in such a way as to address costs as lower or affordable for participants.
“The weighted average lowest monthly premiums for a 27-year -old in 36 states will be (before tax credits): $129 for a catastrophic plan, $163 for a bronze plan, and $203 for a silver plan,” the report states. “More than half of the uninsured potentially eligible for the Marketplaces live in a state where a 27-year-old can purchase a bronze plan for less than $165 per month before tax credits.”
Page 2 of 2 - But, that isn't the case in Arkansas. Weighted average premium costs reflected in the report for Arkansas rank near the upper end of costs among the 48 states that have submitted data to HHS. And, that comparison is offered only for the lowest cost bronze, lowest cost silver and second lowest cost silver plans.
Nationally, weighted average premium costs in Arkansas for those three plans are from $131 to $174 higher than the state with the lowest premium costs and only $26 to $38 lower than the state with the highest premium costs.
In Arkansas, the weighted average premium of the lowest bronze plan cost is $275 per month, the lowest silver plan is $351 per month, and the second lowest silver plan is $366 per month. That compares with $144 per month for the lowest bronze plan, $192 per month for the lowest silver plan and $192 per month for the second lowest silver plan in Minnesota, which has the lowest overall weighted average premium.
Wyoming tops the list for highest weighted average premiums at $425 for lowest bronze, $489 for lowest silver and $516 for second lowest silver plans.