The Pennsylvania Department of Insurance has a good set of data for the plans that they approved with final rates. It is sorted by county, issuer, metal level and price for the 21 year old non-smoker.
Philadelphia is a very large market with very limited competition. There are two insurers offering a total of three Silver on-Exchange plans.
It looks like Philadelphia County will see a Silver Gap strategy in effect for 2017.
For a 21 year old non-smoker, the least expensive Silver plan is $35 less than the benchmark Silver. Applying typical aging factors and a forty year old will see roughly a $50 gap between the plans and a 64 year old would see a $105 gap between the plans. This gap is critical.
As we have looked at, a single individual making $18,000 a year is expected to pay $63 per month post-subsidy for the second least expensive Silver in 2016. A 21 year old in Philadelphia can pay post-subsidy $28 per month while a middle aged individual will be paying a nominal premium if Pennsylvania does not allow for $0 premiums (California does not allow $0 premiums). The same logic applies to 64 year olds.
Looking at the Bronze plans, there is a significant gap between the two least expensive Bronzes and the Benchmark Silver. The 21 year old making $18,000 can buy a free Bronze. More importantly, the healthy mid-thirty something making 225% of FPL can buy a Bronze plan for $65 a month. It is not a great deal but it is a decent deal for someone who is healthy.
The Moar You Know
Can’t get past this. Where I live (CA) $18k/year is “die on the street under an overpass” money. Forget health insurance. Can someone really pull off food, housing and health insurance anywhere in this country on that kind of coin?
Jeffro
@The Moar You Know: And yet…that’s a $9/hour wage (assuming you could even get 40 hours/week)
What’s the minimum wage again?
Pogonip
Hi Richard, my doctor pressures me to have a colonoscopy because the insurance companies pressure HIM. Can you tell me why they would exert such pressure for, in my case, overtesting? (No colon cancer for the last several generations, at least, on both sides of family, and no symptoms.). They have to pay at least part of the cost of this overtesting. So why push it?
Face
I prefer to discuss thigh gap in Philly.
Richard Mayhew
@Pogonip: quality ratings. Routine colonoscopy is a metric that leads to either Medicare Stars which directly tie to revenue or NcQA ratings with an indirect tie.
Pogonip
@Richard Mayhew: And where’s the money? Who gets the ka-ching from all these quality ratings?
Pogonip
@Pogonip: I mean, to put it more coherently, what are NCQA ratings?
Also, what can be done about this? Medical care is expensive enough without pressuring people into overtesting.
Chris T.
@Jeffro: Depends where you are: in some parts of California here (Berkeley), it’s $12.53/hr now, on its way up to $15. Which is still “die on the street under an overpass” level…
Mnemosyne
@Pogonip:
Did you have your baseline colonoscopy after age 50 yet? If so, they’re not supposed to bug you for another 10 years.
People can get colon cancer without a family history, so that’s why they now recommend everyone get a baseline screening at 50+.
Pogonip
@Mnemosyne: No, and I don’t intend to. It is certainly possible to get colon cancer after age 50. It is also possible that an Easter bunny will fall out of a plane on the 4th of July, land on me and kill me. In my case they’re about equally likely to happen. I say save the testing for people who really need it.
Mnemosyne
@Pogonip:
Well, if you’re a non-smoker and non-drinker who exercises regularly and doesn’t eat red meat, you’re probably at low risk, because those are the major risk factors, along with undiagnosed celiac or Crohn’s disease. The genetic link is very weak, so you can’t rely on family history.
EBT
@The Moar You Know: in Cali 18,000 is enough for two people who can really tolerate each other to almost but fall short of getting by.
Richard Mayhew
@Pogonip: CMS Stars is a quality program run by the Center for Medicare and Medicaid Services (CMS). It uses plan claims data to determine if the plan is doing a good job of providing preventive care as well as managing chronic conditions for the Medicare Advantage market segment. 4 and 5 star plans get a payment boost that allows them to offer more services or better cost sharing to members which gives them a significant competitive advantage during Open Enrollment. That is money that is automatically appropriated.
NCQA is the major rating entity for insurers and some medical fields. It is very similar to the Medicare Stars but for a younger population. NCQA rankings are quite useful in selling plans in the large group market (Choose us as NCQA says we’re awesome while the competitor with a 4% cheaper bid has an NCQA rating of “blows goats”)
Pogonip
@Mnemosyne: Yup, I’m officially low risk. That’s nice to know. Thanks!
Pogonip
@Richard Mayhew: Thank you! One more question: will all this annoying overtesting go away when Obamacare does?
amygdala
@Pogonip: It’s not necessarily annoying overtesting. Colon cancer is partially preventable if polyps are removed before they become malignant.
Tommy3320
Hi, Richard. Are the details of these plans available yet? My friend needs a low- or no-deductible plan, and there were a couple Silvers in the 2016 listings that would have fit the bill nicely without costing her a large % of her current earnings, but they are no longer offered (I think they were BCBS or IBX, I forget which).
Ceci n'est pas mon nym
OK, I found my county (Delaware). It is apparently “rating area 8”. Now can you tell me more about how to interpret this? Am I looking at unsubsidized rates? Do I have to add some scale factor to account for the fact that I will be 59+ when I am expecting to sign up in the middle of next year?