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The Patient Protection and Affordable Care Act, ACA or Obamacare for short, created healthcare exchanges, and its implementation had been left up to the states. While 36 states had elected to have the federal government run their exchanges, with more or less success, Connecticut and 23 other states developed and opened their own exchanges.

In this blog, we are going to look at the Connecticut healthcare exchange premiums and the available plans for a couple in their mid-thirties, no kids, within Fairfield County. The target of this evaluation is the estimated yearly cost of these plans; however, we will not look at the actual coverage and provider networks. The cost tables will not take into account the copayments, or the separate prescription benefit’s deductible. Nor will it account for the preventive services that are covered 100% by the insurance companies.

For other age groups and estimated premium rates, please visit the Connecticut Health Insurance Exchange website

The couple in our example has 16 different plans to choose from and just to restate, the actual plan policies had not been evaluated.  The premium for these plans is along the line of metal rating of the plan in question. In addition to the non-metal (rusty?) rated catastrophic coverage, the ACA specifies the metal rating as bronze, silver, gold and platinum. The couple in question does not qualify for catastrophic coverage, due to their age, and Connecticut exchange does not offer platinum plan. After accounting for these restrictions, these are the plans available for this couple:

Based on the estimated premium alone, and depending on the couples yearly income, these premiums certainly seem affordable for an HMO type plan. The ACA introduced HMO plans however are not the traditional HMO plans that we’ve got accustomed to and embrace; these plans are integrating the indemnity plan’s deductible as well. Let’s look at the actual estimated cost of these plans with the policy specified medical deductible added:

The size of the deductible substantially changed the actual cost of the plans, based on the yearly basis, when the couple in question requires medical care. The low cost plans with large deductible are quickly subset in favor of the high premium and lower deductible plans in the total yearly cost of the plans.

The ACA has also introduced the “maximum out-of-pocket” cost limitation; however, the deductible does not count toward the maximum out-of-pocket cost. Let’s add this to the table below to the annual estimated cost of insurance for this couple, who’d actually use their plan:

Adding the maximum out of pocket cost to the yearly total just further underlines the advantage of the gold level plans. It also proves that the “pay me now, or pay me later” is true once again.

Basically the bronze level premium plans end up costing much more than the gold level plans, when all costs are included in the evaluation. The plans available at the Connecticut exchange show similar cost trends for all age groups, with or without children. The difference is that the premiums increase substantially for couples with kids, older couples, and smokers. In the case of older couples for example, the premium rates presented here will double, or more, for a couple in their mid to late 50s in all metal levels.

Selecting a suitable exchange plan for your needs will take time and the evaluation should include:

1. Check for your doctors in the plan’s provider network (Use Connecticut’s exchange site)
2. Based on your medical condition, estimate the care that you may need in the future
3. Evaluate the yearly cost of plans, that includes at the minimum the yearly premium and deductible
4. Select the plan that best fits your needs

Shopping based on the policy premiums only does not take into account the provider network, deductible, and the out-of-pocket maximums. The deductible alone can more than double of the plan’s annual premium cost in case of bronze, and to a certain extent the silver rated plans as well.  Therefore, it is strongly suggested that the estimated yearly cost is taken into account prior to selecting from the Connecticut exchange provided health insurance plans.

Note: These are estimated premium rates, the actual premium rates may increase/decrease if and when the plan had been finalized and purchased from the insurance company in question. And again, do read the plan policy prior to signing on the dotted line.