The law provides subsidies for premiums and out-of-pocket costs for people with incomes below 250 percent of the U.S. poverty line. That’s about $29,000 for a single person or $59,000 for a family of four.
‘Sweet Spot’
“The sweet spot is the people that are low-income and the people that don’t have a lot of health conditions,” said Andrea Croley, a Springfield, Missouri, insurance broker, in a telephone interview. “They can get a pretty good deal.”
Consumers who make more than that or have high medical bills face a tougher situation, said Coleman, the author of HealthPocket’s survey.
“Somebody who’s above 250 percent of the federal poverty level and who uses medical services frequently -- just do the math, they are going to pay more,” Coleman said by telephone.
There are four levels of coverage on the exchanges -- bronze, silver, gold and platinum. Bronze plans, the cheapest and least generous, are designed to cover about 60 percent of medical costs and carry higher deductibles. Platinum plans, the most expensive, cover about 90 percent of costs, yet charge higher monthly premiums.
‘Unlimited’ Expenses
“In the current individual marketplace, consumers can face unlimited out-of-pocket expenses for plans with limited benefits and high deductibles, if they can even get coverage without being denied for a pre-existing condition,” Joanne Peters, a spokeswoman for the U.S. Department of Health and Human Services, said in an e-mail.
The HealthPocket analysis found deductibles in the seven states averaged $4,500.
The company compared high-deductible bronze plans with all policies on the existing market, including more generous ones. Coleman said that was a fair comparison because bronze plans, as the cheapest, are likely to be the most popular with consumers. The pre-Affordable Care Act average also includes some with very high expenses, such as a plan sold in Vermont with a $100,000 deductible, he said.