- About Health Care Law
- Our Position
- Key Provisions
- Frequently Asked Questions
- For Individuals and Members
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- Glossary of Key Terms
Frequently Asked QuestionsAffordability and Cost
1. Does the health care law lower health care costs or premiums?
The new health care law will expand access to coverage and broaden insurance benefits. While these new laws increase benefits and reduce costs for some (especially those who receive a subsidy), others may find they have substantially higher premiums.
2. As a young healthy adult, will my premiums be lower after the law is implemented?
The health care law says that an insurance company cannot set the premium for an older adult at a cost that is more than three times higher than the premium it charges a young adult. In other words, the ratio of the older person’s premium to the young adult’s premium is 3:1. Some health care policy experts say the lowest workable ratio is 5:1. According to research by actuarial consultants Oliver Wyman, this provision probably will increase premiums for young adults.
3. What are the cost-sharing limits that took effect in 2014?
Beginning in 2014, cost-sharing — your out-of-pocket expenses (including copayments, coinsurance and deductibles) — for coverage of certain services will generally be capped at $6,350 for individual plans and $12,700 for family plans. This amount is in addition to your premium.
4. How do I find the most affordable plan?
Independence Blue Cross has an easy-to-use website, where you can buy your health plan. Our shopping tool asks simple questions, and then makes three recommendations based on your answers, including what plans are your most affordable alternatives.
5. What is the most affordable coverage level?
All plans must cover a set of essential health benefits, and the metal levels (Platinum, Gold, Silver and Bronze) correspond to the actuarial value of each plan. For example, Bronze plans must cover at least 60 percent of the cost of an average person, while Platinum plans must cover 90 percent. Bronze health plans will have the lowest monthly costs, but will likely have higher out-of-pocket costs when you receive covered services.
Bronze health plans have the lowest monthly costs but will likely have higher costs when you receive covered services. Bronze plans are for individuals who don’t plan to use a lot of health care services. In addition to Keystone HMO Bronze and Personal Choice® PPO Bronze, Independence Blue Cross also offers Personal Choice Bronze Reserve, a PPO health plan with a health savings account (HAS), which is an even more affordable option.
Silver health plans help balance your medical needs with your monthly premium. In addition to traditional HMO and PPO plans, Independence Blue Cross also offers a Keystone HMO Silver Proactive (an HMO with a tiered network), and Personal Choice PPO Silver Reserve (a PPO with an HSA), which are more affordable than the standard HMO and PPO plans. If you qualify for a cost-sharing reduction from the federal government, the ACA requires that you select a silver health plan. Subsidies to lower your monthly premium costs can be applied to plans on any metallic level.
Gold health plans give you a high level of coverage. Independence Blue Cross offers three gold plans, including Keystone HMO Gold, Personal Choice® PPO Gold, and Keystone HMO Gold Proactive, our new and more affordable HMO with a tiered network.
Platinum health plans offer the highest level of coverage of all metallic plans, and cost the most each month. Because you pay more up front, each time you need covered services, the costs will probably be lower.
Catastrophic health insurance plans are ideal for those individuals under the age of 30 or who qualify for an exemption due to extreme financial hardship. Like the other four types of health plans, catastrophic insurance plans include the essential health benefits, as required by the ACA, but are more likely to have a higher deductible and a lower monthly premium than other health insurance plans.
Individuals will have to reach a deductible of $6,350 before they receive benefits, while families will need to pay a deductible of $12,700 before they receive benefits for covered services. If you select a catastrophic plan, you will get three office visits each year that are not subject to the deductible.
7. What if I can’t afford health insurance?
Some single people and working families will get money in the form of premium tax credits and cost-sharing subsidies from the federal government to help pay their health care costs. Beginning in 2014, if your income falls within the following ranges, you’ll generally qualify for a premium tax credit. The lower your income is within these ranges, the large your credit.
8. Will the cost of my health insurance plan go up because of the ACA?
The cost of health insurance varies by the cost of medical services, such as doctor visits, and hospital and specialty care cost in the state of residence.
The ACA is aimed at making health insurance more affordable and accessible to all. You won’t have to pay more for insurance because you have a medical condition, and that condition will be covered when your policy begins. Older people and smokers can be charged more, however there are restrictions and limits as to how much they will have to pay.