Obamacare
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By Tami Luhby

NEW YORK -- Until now, much of the debate swirling around Obamacare has focused on the cost of premiums in the state-based health insurance exchanges.

But what will enrollees actually get for that monthly charge?

States are starting to roll out details about the exchanges, providing a look at just how affordable coverage under the Affordable Care Act will be. Some potential participants may be surprised at the figures: $2,000 deductibles, $45 primary care visit co-pays, and $250 emergency room tabs.

standard benefits obamacare

Those are just some of the charges enrollees will incur in a silver-level plan in California, which recently unveiled an overview of the benefits and charges associated with its exchange. That's on top of the $321 average monthly premium.

For some, this will be great news since it will allow them to see the doctor without breaking the bank. But others may not want to shell out a few thousand bucks in addition to a monthly premium.

"The hardest question is will it be a good deal and will consumers be able to afford it," said Marian Mulkey, director of the health reform initiative at the California Healthcare Foundation. "The jury is still out. It depends on their circumstances."

A quick refresher on Obamacare: People who don't have affordable health insurance through their employers will be able to sign up for coverage through state-based exchanges. Enrollment is set to begin in October, with coverage taking effect in January. You must have some form of coverage next year, or you will face annual penalties of $95 or 1% of family income (whichever is greater) initially and more in subsequent years.

Each state will offer four levels of coverage: platinum, gold, silver and bronze. Platinum plans come with the highest premiums, but lowest out-of-pocket expenses, while bronze plans carry lower monthly charges but require more cost-sharing. Gold and silver fall in the middle.

The federal government will offer premium subsidies to those with incomes of up to four times the federal poverty level. This year, that's $45,960 for an individual or $94,200 for a family of four. There will be additional help to cover out-of-pocket expenses for those earning less than 250% of the poverty line: $28,725 for a single person and $58,875 for a family of four. The subsidies are tied to the cost of the state's silver level plans.

California offers insight into how much participants will actually have to pay under Obamacare. The state, unlike most others, is requiring insurers to offer a standard set of benefits and charges in each plan level. The only variables are monthly premiums, doctor networks and carriers in your area.
For those in need of frequent medical care, the platinum or gold plans would reduce out-of-pocket costs for treatment. These plans have no deductible, and doctors' visits and medication are cheaper. But the trade-off is that they have higher monthly premiums. California has not yet released the premium range for these tiers.

On the flip side, a young man who never visits the doctor and wants to minimize his monthly charge could opt for a bronze plan. A 40-year-old enrolling in this plan could pay as little as $219 a month. But, if he did get sick, he'd get socked with a $5,000 deductible, $60 co-pays for primary care visits and a $300 emergency room charge.

Obamacare provides protection for those who need a lot of care by placing a cap on out-of-pocket expenses. The maximum a person in an individual platinum plan will spend a year is $4,000, while those in the other tiers will shell out no more than $6,400.

"Insurance is expensive. It's hard for anyone who isn't well off to afford it," said Gary Claxton, director of the health care marketplace project at the Kaiser Family Foundation. "But it is good enough that you can afford to get sick without bankrupting yourself."

Whether potential enrollees find these plans affordable will depend on how healthy they are and whether they are currently insured.

Many individual insurance offerings currently available come with much higher deductibles, cover fewer expenses and limits on how much they'll pay out in a year. Plans on the exchange, on the other hand, are required to cover a variety of "essential benefits," including maternity care, mental health services and medication.

"In many cases, depending on the plan, the coverage will be more comprehensive than what the enrollee currently has," said Anne Gonzalez, a spokeswoman with Covered California, which is running the state's exchange.


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352 Comments

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acts4him

Interesting \"non-statistics\" given by HP and the \"non-partisan\" study, 3 very \"unrelated\" pieces of information tied together \"politically\" to make one think a certain way (percent of uninsured under 65, percent of poor to be helped, how the state voted). OC/ACA is still what it is, a force fed hidden agenda tax disguised as a social program.

June 16 2013 at 2:19 AM Report abuse rate up rate down Reply
h.hughjardon

Obamacare isn't and never was about providing health care or health insurance. It's about redistribution and controlling the individual.

June 15 2013 at 1:44 PM Report abuse +1 rate up rate down Reply
horsehallow

I DONT BELIEVE IN DOCTORS. I HAVENT GONE TO ONE IN 7 YRS AND DONT PLAN ON EVER VISITING ONE IF I DONT HAVE TO. SO WHY THE HELL WOULD I PAY 599 A MONTH BECAUSE THE GOVERNMENT SAYS SO. NO WAY .... I WILL NEVER PAY A PENNY TO HEALTH INSURANCE. NEVER EVER EVER.
SO COME AND GET ME OBAMA. I M POOR. I M OLD. AND IF YOU PUT ME IN JAIL U AND EVERYONE IN THE COUNTRY WILL PAY FOR MY HEALTH CARE. HELL MAYBE I CAN GET SOME TEETH OUT OF THIS. THROW ME IN JAIL AND I LL BE BETTER OFF THEN I AM NOW. THANK YOU AMERICA AND ALL U DONT HAVE TO OFFER THE AVERAGE AMERICAN

June 15 2013 at 3:05 AM Report abuse +4 rate up rate down Reply
Mom and Dad

Those deductibles and copays are all insane. Who's getting rich on all of this?

June 15 2013 at 2:54 AM Report abuse +3 rate up rate down Reply
horsehallow

WHATS HEALTH INSURANCE??? SOMETHING I CANT AFFORD AND DO NOT PLAN ON GETTING. WHAT IS THE GOVERNMENT GOING TO DO ;; PUT ALL THE POOR PEOPLE IN JAIL. I DONT HAVE AN EXTRA 5 BUCK S AT END OF MONTH ,. AND THER IS NO WAY I HAVE 599 A MONTH FOR OBAMA CARE. SCREW THAT .

June 15 2013 at 2:53 AM Report abuse +3 rate up rate down Reply
j550233

Sounds groove is it as affordable as the Affordable Care Act?

June 15 2013 at 12:43 AM Report abuse rate up rate down Reply
teb829

Single Payer,Medicare for all Americans is the ONLY real solution to the nightmare of healthcare in the United States. HR676 sponsored by John Conyers would put single payer before Congress.. Problem is,the Republicans don't want to hear it...The repubs want to get rid of Social Security, Medicare and don't want Universal Healthcare in the United States..Get rid of every one of them in 2014.

June 15 2013 at 12:30 AM Report abuse rate up rate down Reply
4 replies to teb829's comment
h.hughjardon

Nobel Prize winning “economist” Paul Krugman spoke at Sixth & I Historic Synagogue in Washington, D.C., last Wednesday evening. During the Q&A session following the lecture, an audience member asked him about the rising national debt.

Earlier in the evening, Krugman had already vocalized his satisfaction with President Obama’s apparent lack of concern over the exploding cumulative deficit. However, in a moment of brutal honesty, the esteemed Princeton professor revealed his long term prognosis. According to the professor:

Eventually we do have a problem. That the population is getting older, health care costs are rising…there is this question of how we’re going to pay for the programs. The year 2025, the year 2030, something is going to have to give…. We’re going to need more revenue…. Surely it will require some sort of middle class taxes as well..... We won’t be able to pay for the kind of government the society will want without some increase in taxes…. on the middle class, maybe a value added tax…. And we’re also going to have to make decisions about health care, doc pay for health care that has no demonstrated  medical benefits . So the snarky version…which I shouldn’t even say because it will get me in trouble, is death panels and sales taxes is how we do this.

June 15 2013 at 12:11 AM Report abuse +2 rate up rate down Reply
1 reply to h.hughjardon's comment
h.hughjardon

Looks like a lot of people owe Sarah Palin an appology.

June 15 2013 at 12:12 AM Report abuse +5 rate up rate down Reply
Condley

Interesting how some politicians were complaining about the "cost" of tax cuts. I wonder if those same hypocrites are complaining about the "costs" of this tax deduction?

June 14 2013 at 11:33 PM Report abuse +2 rate up rate down Reply
1 reply to Condley's comment
h.hughjardon

I sense some.sarcasm, like the fact that tax cuts don't cost...as revenue and spending are not the same thing.

June 14 2013 at 11:44 PM Report abuse +3 rate up rate down Reply
JOE & SHEILA

a lot of us older folks will not be able to afford this , so I guess we will just have to die off

June 14 2013 at 11:27 PM Report abuse +2 rate up rate down Reply
1 reply to JOE & SHEILA's comment
Rob

That is just what the government would like. Death panels, as Krugman called them, will decide who gets the care and we have seen in other government health systems that once you hit fifty or so you are considered expendable. Obama himself has said the emphasis is on preventative care. If your preventative selections leave you on the short end of the stick that will be just too bad and that is if you can afford the plans.... I am sure there will be much backslapping among democrats as the cost of medicare and social security decline due to the refusal of care. When your insurance company says no you can sue or use public opinion. When the Federal Government says no to your care they will just tell you to shut up, go home and die. You can't sue and they will spin the story just like they do for everything else. Land of the young - but the young forget they will be the older in too short of time.

June 15 2013 at 1:11 AM Report abuse -1 rate up rate down Reply
1 reply to Rob's comment
mrspelosi

Mildred darling I was unaware that you made up the term death panel. Don't be so hard on yourself dear. After reading many of your posts you really don't seem very bright doll. How unfortunate for you.

June 19 2013 at 8:11 PM Report abuse rate up rate down