Rock County health exchange rates lower than most counties

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Jim Leute
Saturday, October 19, 2013

JANESVILLE—Rock County residents using the federal health exchange to buy health insurance will be paying some of the lowest rates in Wisconsin.

That's due in part to fierce health care competition in neighboring Dane County, said Michael Bare, research and program coordinator for Community Advocates in Milwaukee.

Bare's organization is developing an analysis on how much the plans could cost individuals and families in the exchange marketplace created under the federal Affordable Care Act, also known as Obamacare.

The organization also is working to develop comparisons between Wisconsin's 72 counties to determine which have the cheapest premiums.

A Gazette analysis of Bare's information shows only residents of 13 other counties will pay lower rates when the marketplace insurance plans begin Jan. 1.

“There's a competitive environment that exists in our county and in this region,” said Joe Nemeth, vice president and chief operating officer of MercyCare Health Plans in Janesville. “In a competitive situation, you get people striving to provide the best quality in the most efficient manner, and that results in lower costs that benefit consumers.”

Bare said insurers in Rock County also compete in Dane County, which, he said, is fiercely competitive among health systems that are vertically integrated.

Vertically integrated systems provide a wide range of services, including primary, specialty, urgent and emergency care; inpatient and outpatient hospitalization; home care; and insurance products.

“With these systems, the goal is healthier patients, better care and better quality,” Bare said. “The savings take the form of lower rates.”

Mercy's Nemeth agreed: “There's no question that integration helps lower the costs.”

In Rock County, Mercy, Dean and Group Health Cooperative are offering 33 plans in five tiers of coverage: catastrophic, bronze, silver, gold and platinum.

All exchange insurance plan categories offer the same set of essential health benefits.

It's the category chosen that affects monthly premium costs and the portion of bills the insured must pay.

Basically, the lower the premium, the higher the out-of-pocket costs.

The difference among coverage tiers rests with their “actuarial” value—how much a plan will cover before the patient must chip in for co-insurance, deductibles and co-payments.

The actuarial values for bronze, silver, gold and platinum levels are 60 percent, 70 percent, 80 percent and 90 percent, respectively.

For example, someone who gets a silver plan would have to pay 30 percent of health care costs. The plan would cover 70 percent.

In Rock County, Dean Health Plan is offering eight plans in the bronze category, four in the silver category and one in the gold category.

In contrast, MercyCare Health Plans has one plan each in bronze, silver and gold.

“Our approach was to try to mirror these exchange plans to what we sell in the commercial market,” Nemeth said. “We wanted to reduce complexity. That was our strategy. The rationale is the same, and we didn't see the need for several variations of the same plan.”

Bare said it's not uncommon for one insurance provider to offer multiple plans in one or more categories.

“All bronze plans will cover 60 percent, but it's how the remaining 40 percent gets split up between deductibles, co-payments and co-insurance that makes the plans different,” he said.

A Dean Health Plan spokesman did not respond to Gazette requests for information about that company's strategy of offering multiple plans in different categories.

In Rock County, the data show premiums for a 27-year-old individual ranged from $178 to $304 for bronze coverage, $197 to $347 for silver, $265 to $390 for gold and $428 to $432 for platinum.

Those costs jump for 50-year-old individuals in Rock County, with the ranges being $304 to $518 for bronze, $336 to $592 for silver, $451 to $664 for gold and $729 to $737 for platinum.

The costs approximately double for a Rock County family.

The ranges for a family—defined as two 30-year-old adults and two children—are $602 to $1,026 for bronze coverage, $667 to $1,173 for silver, $894 to $1,316 for gold and $1,444 to $1,461 for platinum.

Costs are lower for single-parent families in Rock County.

The premium ranges for those families are $409 to $697 for bronze, $453 to $797 for silver, $607 to $894 for gold and $981 to $992 for platinum.

Premiums for a couple, defined as two 40-year-olds, range from $435 to $741 for bronze, $481 to $847 for silver, $645 to $950 for gold and $1,043 to $1,055 for platinum.

While those are the published ranges, actual pricing could vary significantly because of factors such as tobacco use and individual or household income.

Premium tax credits are available to help individuals and families with incomes between 100 and 400 percent of the federal poverty level. People who earn less than 250 percent of the poverty level could receive additional cost-sharing subsidies.

“There are millions of permutations for unique circumstances,” Bare said. “The best way to find out what your rate will be is to log on to healthcare.gov and see what you get.”

Last updated: 10:48 am Monday, October 21, 2013

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