Prices on Nebraska's health insurance exchange made public Thursday appear higher than the prices on most existing individual policies, according to a State of Nebraska comparison.
The exception in the sampling is for a 26-year-old single female.
Some rates in the comparison were more than double those of 2013, while some were down as much as 22 percent. But the comparisons are inexact because the exchange, or marketplace, policies provide more coverage than 2013 policies. Some plans and insurers aren't included in the comparison samples.
Also, the rates posted on the Nebraska Department of Insurance's website don't show the federal subsidies that would offset the higher premiums for an estimated 169,000 people who may buy the coverage under the Affordable Care Act, also known as Obamacare.
“Basically, the rates are going up,” Nebraska Insurance Director Bruce Ramge said. “But it's going to be different in every different situation. You'll see a wide variety of swings in the rate comparison because the plans are different from last year.”
The state included rates from only two of the four insurers in the exchange because it didn't have 2013 rates to compare, Ramge said.
The rates posted Thursday afternoon by the department do not apply to people who belong to insurance groups or who receive Medicare, Medicaid or Tricare, the health plan for military families.
Insurance executives said policies sold on the exchange will provide much broader coverage than most individual policies in effect today, with features such as no cap on maximum benefit payments.
“It's not an apples-to-apples comparison,” said Tom Gilsdorf, director of product development for Blue Cross Blue Shield of Nebraska, the state's largest health insurer and one of four offering policies on the exchange.
The increases shown in the state's comparison do not mean that group insurance rates will go up as well, Blue Cross said, because group policies are substantially different from individual policies.
“I know there are some rate shock issues,” said David Lyons, CEO of CoOportunity Health of West Des Moines, which also will sell individual insurance policies through the exchange.
“We really hope people take a strong look at the marketplace, and when it comes down to it, compare and shop,” he said. “They should find some opportunities to reduce their overall health care costs. The total cost to consumers probably is going to come down,” especially because of the subsidies and lower co-payments and deductibles.
Consumers who have individual insurance also will receive information from their carriers about their options before the date they need to renew their plans, said Jessica Henely, a spokeswoman for Coventry Health, also on the exchange. The fourth company is Health Alliance of Urbana, Ill., which did not return a call for comment.
Obamacare requires individuals to have coverage that provides 10 “essential health benefits,” some of which were not included in most previous policies.
The essential benefits: outpatient care; emergency services; hospitalization; maternity and newborn care; mental health and substance abuse services; prescription drugs; rehabilitative services; laboratory services; preventive and wellness services and chronic disease management; and pediatric dental and vision services.
Ramge said he posted the information on the department's website because Nebraska's public records law requires such information to be public as soon as it is available.
Other states with federally assisted exchanges, including Iowa, are waiting until federal approval of policies on their exchanges. That step is to be completed in mid-September. The exchanges are scheduled to open on Oct. 1.
Business owners in Nebraska have been waiting for the State Department of Insurance to release the health insurance plans that four health insurers proposed about a month ago.
“It's hard to plan or make any kind of decisions, what would be the best for the employees and us as a business, without knowing what kind of money we're talking about, where the rates are and what the coverage is,” said small-business owner Carol Palmier of Bellevue.
Now that the numbers are public, she said, “My plan is to go to the website and explore, just to get some awareness, at least to start the process and educate myself. It'll probably bring a lot more questions, but at least it's a good start.”
That's exactly what consumers and small-business owners should do, said Blue Cross' Gilsdorf. He pointed out that the state's comparison did not list the lowest-cost policies, which have been among the most popular for individuals.
Exchange policies are ranked from low-cost bronze to silver, gold and high-cost platinum, depending on the percentage of claims each would pay.
Blue Cross will offer a $195-a-month bronze policy to 26-year-old singles, less than the $239 silver policy shown in the state's comparison.
Rather than an $867 monthly premium for a family of four with a silver plan in the state's comparison, Blue Cross' bronze plan would cost $710 a month. A $1,707 premium for a couple age 60 on a gold plan could be replaced with a $1,038 premium on a bronze plan.
Instead of the gold policy covering 80 percent of health care costs, the bronze would cover 60 percent.
Blue Cross will recommend bronze plans to its current 45,000 individual policyholders as being the closest to their present plans, Gilsdorf said. Blue Cross will not offer platinum plans, he said, because the other three levels offer enough choices for consumers in the state.
CoOportunity will offer platinum plans, Lyons said, because there appears to be demand, especially among self-employed people, for strong insurance protection. He noted that young people also should look into low-cost policies that cover mostly “catastrophic” medical expenses, but state officials pointed out that such policies aren't eligible for subsidies.
Gilsdorf said people buying coverage on the exchange can qualify for subsidies if their household incomes are below $47,000 for an individual and $94,000 for a family of four. He said those subsidies would reduce or in some cases eliminate monthly premiums.
Provisions of Obamacare will result in some higher costs for some consumers. Young males, for example, will have generally higher premiums because the policies can't set rates by gender. Women of child-bearing age generally will see reductions because their premiums have been higher.
Older people also may see reductions because the law limits the differences insurance companies can charge between the highest and the lowest rates.
The law also allows insurers to vary premiums according to four different regions in the state. Blue Cross will charge the same premiums across the state. CoOportunity will vary premiums depending on hospital costs in the different regions, with Omaha rates slightly higher.
CoOportunity, which is new to Nebraska and got some startup funds from Obamacare, will add competition by offering statewide insurance, Lyons said, and features such as no out-of-pocket costs for three doctor visits a year.
The posted state information showed the various companies' 2014 rates for the first time under the Affordable Care Act. Lyons said he was “very excited” at how CoOportunity's rates compared with competitors' rates.
Gilsdorf, from Blue Cross, said the good news is that more people can get into the state's insurance pool through the exchange, whether they have health problems or not.
“I would suggest that everybody should get educated and talk to somebody in the know about what their options are,” he said, such as an insurance agent. “Joe Consumer is not going to be an expert in navigating all these options.”
Palmier — who owns Yeck's Auto Repair on Fort Crook Road in Bellevue with her husband, Greg, and partner Mark Lowe — said about half of their 10 employees are covered by a group policy through Coventry Health, and others have coverage elsewhere.
But the exchange might offer the employees better coverage at an affordable price, she said. “I just want to do what's best for them and for our business, too.”
Maybe she should renew the Coventry policy. Maybe she should switch to another carrier. Maybe the exchange would be cheaper than a group plan, since some of her employees probably will qualify for subsidies that would reduce their monthly premiums.
“I'm excited to find out about that,” Palmier said. “Hopefully, that may meet our needs.”