Friday, July 11, 2014





OTHER OPINION: ‘Obamacare’ exchanges Beware differences in health care plans


October 09. 2013 11:40PM
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The online health insurance exchanges promised by “Obamacare” promptly opened for business last week and just as promptly crashed. People seeking to sign up for insurance, or just peruse plans, waited and waited … and waited.


Eventually, we’re sure, the computer problems will be resolved. But many people will find that when they can get through, they’re confronted with a bewildering online experience. They’ll have to sort through dozens of plans from different insurers.


This is a complex decision. Some people might be tempted to throw a dart and pick one with the lowest premiums, assuming all plans are about the same.


Warning: They’re not.


In recent weeks federal officials touted some of the low premium prices available under the new exchanges. What they didn’t stress, and what careful consumers will find on the exchange market site, is that insurers have tamped down prices in some cases by greatly narrowing the hospitals and doctors available in the coverage network. That means if you favor a particular hospital, you’ll want to make sure that your plan covers that hospital and your doctors.


If not, you could be on the hook for much higher medical bills for out-of-network coverage, even though you have insurance.


Let’s back up for a second. “Obamacare” sets four levels of coverage: platinum, gold, silver, bronze. The law requires that every plan provide a basic menu of services, including maternity care, mental health services, prescription drugs and hospital visits. Insurers can offer more than that, but they can’t offer less.


That doesn’t mean all gold plans — or silver or bronze — are created equal.


The differences within a tier can be huge. Blue Cross and Blue Shield of Illinois, for instance, offers some customers its Blue PPO Gold plan for 314.19 a month or its Blue Choice Gold PPO for $234.02. The plans have the same deductible. Same coinsurance. Same copays. So what accounts for the $80.17 difference in monthly premium? One major factor: The higher-priced plan has 54 hospitals in its network, including world-class Northwestern Memorial Hospital, and more than 23,000 doctors. The lower priced plan has 26 hospitals, excluding Northwestern. It has about 10,000 doctors.


Don’t assume anything.


There’s plenty of time to investigate before you decide. You can enroll until Dec.15 for insurance that begins Jan. 1.


If you find yourself confused, be reassured: You are not alone. Almost all the experts we’ve talked to — insurance agents, hospital officials, doctors — are still sorting out the details of this massive health care expansion.


Chicago Tribune




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