The prices of the health insurance plans to be offered next year on the Obamacare exchange in Rhode Island are now available.
But this long-awaited information varies depending on the type of plan and the individual's age. As a result, few generalizations can be made, and no "average" or "typical" plan can be identified. Comparisons also cannot be made with current premiums, because the plans are designed differently.
Still for the first time, starting tomorrow, individuals and small businesses will be able to visit HealthSourceRI.com to view a list of premiums by plan and age, with a summary of the differences among the plans. More sophisticated systems for calculating costs are expected to be online by the time enrollment starts on Oct. 1.
Individuals will have a choice of 12 insurance plans offered by Blue Cross & Blue Shield of Rhode Island or Neighborhood Health Plan of Rhode Island.
Here are a few examples:
-- A 45-year-old buying a plan as an individual will pay $377 a month for a Blue Cross plan with a $1,500 deductible but no co-pays for medical care. A 21-year-old would pay $261 for the same plan.
-- A 45-year-old also could also choose a plan costing $244 a month; this plan has $5,800 deductible and 30 percent co-pays on many medical services. A 21-year-old could get this plan for $169 a month.
-- People under 30 can buy low-cost "catastrophic" plans with a $6,350 deductible ($12,700 per family), ranging from $95 to $168 depending on age.
Businesses with 50 or fewer employees will have a choice of 16 plans offered by Blue Cross, Neighborhood and UnitedHealthcare of New England. These are priced slightly higher than the plans for individuals. For 21-year-olds, the premiums range from $187 to $378, and for 45-year-olds $270 to $545.
"The premium is only one piece of the puzzle," cautioned Christy Ferguson, director of HealthSource RI, the state agency that is running the exchange. "Just looking at the premiums is not a good way to compare."
People selecting a plan will also have to consider how much they will have to pay each time they use a medical service. In some plans, that amount varies depending on which providers you choose.
But every plan has a limit on out-of-pocket costs, including both deductibles and co-pays (but not premiums). The highest allowable out-of-pocket cost is $6,350 for an individual or $12,700 for a family, but some plans cap out-of-pocket costs much lower. The plans with lower caps, however, will have higher premiums.
The premium numbers are also misleading because not everyone will have to pay the full premium. A significant number of people will be eligible for federal tax credits, based on their income; these credits will be applied immediately to reduce the premium cost.
All of the plans cover the same set of services, including doctor's visits, emergency care, hospitalization, mental health and substance abuse treatment, and prescription drugs. Certain preventive services, such as mammography or colonoscopy, are covered with no out-of-pocket costs.
For those who obtain health insurance from employers with more than 50 employees, these premiums do not apply.
But Rhode Islanders who don't have access to employer-based health insurance (estimated at 60,000) and people employed by small businesses (along with their dependents, an estimated 300,000) can now get a rough idea of the options they will have by consulting a list of premiums by age and plan that will be available on HealthSourceRI.com. Enrollment starts on Oct. 1 for plans that take effect during 2014.
Eventually, people will be able to enter their demographic and income information to access a list of applicable plans, as well as getting individualized help by phone or in person from the HealthSource RI contact center, which opens next month.