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This post comes from Mark Chalon Smith at partner site Insurance.com.
Anyone shopping for health insurance in a Colorado resort town may feel like closing the laptop and schussing the slopes to ease frustration. These areas were just named the most expensive for medical coverage under the Affordable Care Act, commonly known as Obamacare.
Kaiser Health News — which based its findings on recent data from the Kaiser Family Foundation, the federal HealthCare.gov website and state exchanges — gives Colorado’s Eagle, Garfield and Pitkin counties (including the Aspen and Vail ski getaways) the highest premiums, at $483 a month.
Rural regions of Georgia, Mississippi and Nevada are not far behind, as is a Connecticut suburb of New York City, all of Alaska and most of Wyoming. The premiums are based on the lowest price silver plan, which is mid-level coverage that most consumers are buying through the exchanges.
Here are the 10 most costly areas, based on monthly premiums, according to Kaiser Health News:
- $483 — Colorado mountain resorts (Eagle, Garfield and Pitkin counties). Also, premiums in Colorado’s Summit County are $462.
- $461 — Southwest Georgia (Baker, Calhoun, Clay, Crisp, Dougherty, Lee, Mitchell, Randolph, Schley, Sumter, Terrell and Worth counties).
- $456 — Rural Nevada (Esmeralda, Eureka, Humboldt, Lander, Lincoln, Elko, Mineral, Pershing, White Pine and Churchill counties).
- $445 — Western Wisconsin (Pierce, Polk and St. Croix counties).
- $423 — Southern Georgia (Ben Hill, Berrien, Brooks, Clinch, Colquitt, Cook, Decatur, Early, Echols, Grady, Irwin, Lanier, Lowndes, Miller, Seminole, Thomas, Tift and Turner counties).
- $405 — Most of Wyoming, but excluding Natrona and Laramie counties.
- $399 — Southeast Mississippi (George, Harrison, Jackson and Stone counties). Also, the lowest priced plan in Hancock County is $447.
- $395 — All of Vermont.
- $383 — Southwest Connecticut (Fairfield County).
- $381 — All of Alaska.
The Kaiser report says the lofty premiums in Colorado can be blamed on high costs for medical care in those areas. In other pricey regions, insurers are able to ask for more money because there is a limited number of hospitals and specialists available to patients.
“High individual insurance rates also reflect the extra costs that come when locals tend to be in poor health and where large numbers of people lack employer-sponsored insurance, leaving providers with more charity cases and lower-reimbursed Medicare patients,” the report said.
Health insurance options beyond the health insurance exchanges
The ACA requires that the uninsured have coverage by the March 31 deadline or face a penalty. The fine in 2014 is $95 or 1 percent of an individual’s taxable income, whichever is higher. The penalty climbs to $325 in 2015 and $695 by 2016.
Subsidies are available to help shoulder costs for those who qualify. Consumers are eligible for a tax credit if they earn up to 400 percent of the federal poverty level — that’s $94,200 for a family of four in 2013. The tax credits are not available for health insurance purchased outside the exchanges.
You can shop for insurance through the government-run exchange in your state, but there are other options:
Can you get it at work?
Most employer-sponsored plans meet minimum standards set by the feds; your boss should have notified you of that by Oct. 1. Keep in mind, though, that most employer-based plans have open enrollment in the fall. Your workplace can give you the specific details, including deadlines.
Does an employer’s plan cover spouses or dependents?
Most work-based health plans extend benefits to spouses, even though they aren’t legally required to. Again, check with your employer.
Also, anyone under 26 can remain on their parent’s medical plan, even if they already have access to health insurance elsewhere, don’t live with them or are married.
Do you qualify for a government health insurance plan?
The ACA says you’re covered if you have Medicare or Medicaid; your kids are covered if they receive benefits under the Children’s Health Insurance Program.
Medicare is usually available to anyone who is 65 or older or has a disability or end-stage renal disease. You have a seven-month period (starting three months before your 65th birthday) to sign up for Medicare at the government’s Medicare.gov site. If you don’t sign up then, you can enroll from Jan. 1 to March 31 of each year.
Medicaid eligibility, which has been expanded under the ACA, is based on income and family size. Do you qualify? You can fill out an application at your state’s health insurance exchange to find out. You can also see if your kids can be covered through the Children’s Health Insurance Program.
Go directly to a health insurer
Some companies that offer medical coverage — including United Healthcare, Humana, Aetna, Cigna and Coventry — aren’t participating at some of the online exchanges. But, of course, they’re still selling health insurance.
You can get relevant information by checking out their websites, talking to their representatives or working with an insurance agent. These companies may provide a larger variety of plans than the exchanges, which offer more standardized coverage.
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