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Map courtesy N.C. Department of Insurance

Originally published: 2013-10-15 20:12:06
Last modified: 2013-10-16 13:02:06

Comparison shopping

by Anna Oakes

Watauga County's premiums on the new Health Insurance Marketplace are among the highest in the state before federal government subsidies are factored in, according to plan information available at

Using information from the website's database of Health Insurance Marketplace premiums, Watauga Democrat compared the lowest-priced Bronze and the highest-priced Platinum plan premiums for individuals ages 27 and 50 in Rating Area 3, which includes Watauga, Ashe, Alleghany and Wilkes counties.

On the low end, Rating Area 3 premium costs were the most expensive for both age groups out of 16 rating areas in the state. On the high end, Rating Area 3 premiums were the third most expensive in the state.

In the Health Insurance Marketplace -- which was established by the Affordable Care Act and opened for enrollment beginning Oct. 1 -- Bronze plans cover about 60 percent of health care expenses: Silver plans cover 70 percent; Gold plans, 80 percent; and Platinum plans, 90 percent. Catastrophic plans are available for those 30 and younger or for individuals who are granted a hardship exemption.

The comparison did not account for federal government subsidies that may be applied to Marketplace premium costs for those who are between 100 and 400 percent of the federal poverty guideline, which is currently set at an annual income of $11,490 for a single person and $23,550 for a family of four.

Under the Affordable Care Act, health insurance plans may not be priced according to such factors as health status or gender. Instead, only three criteria factor into premium costs: age, tobacco use and geographic location.

A spokesperson with the federal Centers for Medicare & Medicaid Services noted that the geographic location criterion incorporates factors such as different levels of competition, regional variation in prices paid to providers, different product and issuer mixes and state choices in implementation of the Health Insurance Marketplace.

Only two insurance companies are currently offering plans on North Carolina's Health Insurance Marketplace, and of those, only Blue Cross Blue Shield offers plans in Rating Area 3.

"There are a lot of factors that go into how much customers are going to pay, (including) what region they're in and what the underlying costs are in that area," said Jinda Stoll, senior marketing strategist for Blue Cross Blue Shield North Carolina. "We have to make sure that we're pricing according to the market. In terms of what the customer is going to pay, it's really going to depend on where they are, and if they're eligible for subsidies."

Lew Borman, spokesman for BCBSNC, noted that it's difficult to take a snapshot and point to which plans are the most expensive and the cheapest. But, Borman said, "when you're in a situation like Watauga that probably has fewer providers and less competition, different kinds of plans are available that would speak to that."

Andrea McDonough, an agent with State Farm Insurance in Boone, said she has never compared local health insurance premiums with premium costs in other areas of the state.

"For health insurance, rates are going to be based on the cost of care," McDonough said. "If it costs more to receive medical care here, then generally there will be higher rates. That is just one factor."

McDonough said she did not know if the general costs of health care are greater in this area than other areas of North Carolina, but she said she has compared the cost of elder care, including nursing home care and home health, and has found that it is "generally lower."

In Watauga County, 14 individual health plans are available on the Marketplace, with plans ranging from $176.51 to $387.70 for a 27-year-old adult and $383.31 to $660.71 for a 50-year-old adult, before subsidies. Group health plans are also available on the Marketplace, as are dental plans.
Subsidy calculators are available on the websites of the Marketplace, BCBSNC and other organizations.

"The subsidy impact will be significant for some," a BCBSNC press release stated Sept. 26. "For example, a person earning 100 percent of (the federal poverty line) could pay $19.15 per month for a Silver plan."

Borman said he was aware of someone whose Marketplace premium costs will be zero after subsidies are applied.

In cases where more than one Bronze, Silver or Gold plan is available, the differences within metal level plans may pertain to deductibles, co-payments, network coverage and other options, Stoll said.
"While the metallic levels are helpful, they don't necessarily capture the full picture," she said. "It's not all apples to apples."

Under the Affordable Care Act, all insurance policies -- not just those sold on the Marketplace -- must meet new minimum standards, including coverage of 10 essential health benefits: ambulatory services, emergency services, hospitalization, laboratory services, maternity care, mental and behavioral health, pediatric vision and dental, prescription drugs, preventative wellness services and rehabilitative and habilitative services.

Insurance companies say that's why some insurance customers could see the costs of their premiums increase.

BCBSNC said that after the impact of subsidies, it expects about two-thirds of individual customers to see their premiums decrease or increase at rates similar to previous years, while the remaining one-third will see "fairly substantial increases due to the requirements of the ACA."

"(It's) more robust coverage and benefits. Many people will be buying more coverage than they have had before," Borman said.

Borman noted that the same plans offered by BCBSNC on the Marketplace are available to consumers outside of the Marketplace as well. He declined to disclose the number of people who have enrolled thus far in Marketplace plans.

"We've had just record-breaking numbers asking for rate quotes, looking at the research, going to our website," he said. "There's clearly a lot of interest in what's going on in terms of actual signups. We've been successful early on."

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