Rushville Republican

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January 14, 2014

What you need to know about the Affordable Care Act

(Continued)

What are my options?

For many in the 6th District, health insurance options on the exchange are limited and vary by county. Seventeen of the 19 counties in our district are limited to one or two insurance providers—MDwise and/or Anthem. If you live in Delaware or Randolph counties you have three providers from which to choose including Anthem, PHP and MDwise. Because of these limited options, you may have to switch physicians and preferred hospitals if you select health insurance through the exchange website instead of in the individual marketplace.

What are the costs?

When comparing health insurance plans on the Federal exchange website, you will notice Bronze, Silver and Gold plans. Those categories determine your deductible, yearly out-of-pocket maximum, and your share of the cost for medical care after you’ve paid your monthly premium.

Bronze Plan: Lowest monthly premium, but highest out-of-pocket costs. After your monthly premium, you pay 40% of the cost for doctor visits, medical procedures, tests, etc. The plan pays 60%.

Silver Plan: Monthly premiums are higher than the bronze plan, but out-of-pocket costs are slightly less. You pay 30% and the plan pays 70% of your medical costs after your monthly premium is paid.

Gold Plan: Highest monthly premium, but lowest out-of-pocket cost. After your monthly premium, you pay 20% and the plan pays 80% of your medical costs.

Your monthly premium, your deductible and out-of pocket maximum will vary based on the plan you select, your age, income and where you live. Let’s walk through what that might mean for a typical consumer. Based on estimates from healthcare.gov, if, for example, you live in our district and have a family of four with a combined income of $40,000 a year, your monthly premium could be as little as $7 a month after receiving a government subsidy. Your deductible will range from $7,000 to $12,600 depending on the plan you choose. Gold plans have lower deductibles and out-of-pocket expenses, but premiums are much higher. It is also important to keep in mind, your children could be eligible for free or low-cost health care through the Healthy Indiana Plan, and you could be eligible for a federal subsidy to off-set the costs of your monthly premium. You can find information on the Healthy Indiana Plan at http://www.in.gov/fssa/hip/

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