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Options Aplenty, Lower-Than-Expected Premiums for Pittsburghers in Health Insurance Marketplace

The U.S. Department of Health and Human Services said Wednesday that people will have more options in the health insurance marketplace and premiums will not be as high as originally thought. 

Premiums nationwide will be about 16 percent lower than originally expected.

“In the past, consumers were too often denied or priced-out of quality health insurance options, but thanks to the Affordable Care Act, consumers will be able to choose from a number of new coverage options at a price that is affordable,” Secretary Kathleen Sebelius said in a statement. 

Because Gov. Tom Corbett opted out of running the state exchange, the federal government is running Pennsylvania’s health exchange, a compare-and-contrast health insurance marketplace.

There are four types of plans: bronze, silver, gold and platinum. The differences between the plans are the actuarial value, said Joanne Grossi, regional director for the U.S. Department of Health and Human Services.

“If you have a bronze plan, it means the plan covers 60 percent of the benefits and you're responsible for the other 40 percent," she said. "Silver is a 70-30 plan and gold is an 80-20 plan.” 

For comparison’s sake, Medicare is an 80-20 plan, the equivalent of a gold plan.

There are also catastrophic plans for people under the age of 30. It does as it says, covering catastrophic care and a few primary care visits. Those can also be purchased on the exchange. 

The law requires all insurers to offer the same types of plans. The only way the pool can shift is by the number of insurers in the pool.

Pennsylvania has some of the lower-cost premiums. Someone who buys health insurance on the federally run exchange will pay $286 a month on average for a mid-range plan. That doesn’t include out-of-pocket costs or tax credits for lower-income families.

The national average is $328.

Other factors such as age, tobacco use, income and family size could affect the premiums. According to preliminary numbers, a family of four with an income of $50,000 could enroll in the silver plan for $282 a month after the federal subsidy. Without the subsidy the premium would be $505.

A 27-year-old earning less than $25,000 would pay $134 for the silver plan with or without the subsidy. 

On average, people in Pennsylvania will be able to choose from among 56 coverage plans, although those vary by region. Thirty-six plans from varying carriers will be available in Pittsburgh. In contrast, in neighboring West Virginia, people can chose from 12 plans all from Highmark Blue Cross Blue Shield.

“What you're seeing again is what we hoped would happen is that competition is bringing the price down," Grossi said. "Exactly what we predicted would happen is coming true."

Official plan details will be available on Oct. 1 when the health insurance exchanges open.

There are 1.3 million uninsured people in Pennsylvania. More than 650,000 people in Pennsylvania are expected to buy health insurance through the marketplace. The other 650,000 would be eligible for Medicaid if it were expanded.

Pennsylvania is not planning on expanding Medicaid, the federal-state insurance plan for the poor and disabled. Earlier this month Corbett proposed a new plan, which would expand Medicaid as well as make sweeping changes to the program. He has been in talks with the federal government regarding the plan.

Erika Beras (she/her) is a reporter and host for NPR's Planet Money podcast.
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