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A Confederacy of Choices: Marketplace Plans Vary Widely In Costs, In Counties And Across U.S.

| October 5, 2013

Modern-time marketplace.

Modern-time marketplace.

Consumers shopping in the new health insurance marketplaces will face a bewildering array of competing plans in some counties and sparse options in other places, with people in some areas of the country having to pay much more for the identical level of coverage than consumers elsewhere.

A Kaiser Health News analysis of the 1,923 plans being sold on federally run online marketplacesfound wide variations of price and availability. For instance, Cigna is offering 50-year-olds one of its midlevel plans for $614 if they live in Flagstaff, Ariz. That same plan, contracting with different hospitals and doctors, will cost $428 in Phoenix and just $395 in Nashville.

Where and How to Shop for a Plan in Florida:


Floridians don’t have to wait until the crowds and glitches diminish on the federal website to see which local plans are available. They can view a PDF with all of the plans available in Florida and can also download information about the plans and prices for Florida and other states at this site.

The data don’t include information about premium subsidies. To get a better idea on the actual price,  use this calculator.
--Health News Florida

These are plans being sold in the 34 states where the Department of Health and Human Services is running the marketplaces or working in partnership with the states. Most plans fall into two types: 806 are health maintenance organizations (HMO) plans, in which patients have to stay within the network of doctors and hospitals that have contracts with the insurer, while 714 plans are preferred-provider organizations, where the insurer has discounted rates with some doctors and hospitals and agrees to pay some portion of the cost if the patient goes to a provider that is out of that network.

All the plans take effect in January, although consumers can shop and sign up before then. They are designed for people who don’t get health coverage through their employer or through a government program, such as Medicare or Medicaid.

Policies are grouped into four tiers of coverage – platinum, gold, silver and bronze – to help buyers compare policies. Policies in tiers named for less valuable metals generally have lower premiums. But the trade-off is insurers pick up less of the costs of medical care than they do in the higher metal tiers. People earning below 400 percent of the federal poverty level (about $46,00 for an individual and $94,000 for a family of four) will get subsidies to help pay the cost of the insurance.

The KHN analysis of premium rate data released by federal officials focused on plans that are offered to consumers of any age and excluded 23 child-only plans and 186 catastrophic plans that pay for most expenses only after the beneficiary satisfies a large deductible.

Insurers offered 158 plans in eastern Florida’s Seminole County, the most available in any single county, and 50 or more plans in 217 other counties across the country. On the other end of the spectrum, shoppers in 161 counties will have 10 or fewer plans to choose from. In sparsely populated Florence County, on the northern border of Wisconsin, Molina Healthcare, an HMO that also runs Medicaid plans in a number of states, was the only insurer to offer coverage: two plans. One costs $1,064 a month for a family of 30-year-old parents and two children. The other plan would cost $944 a month for that family. (Families with more children or older parents will pay higher premiums.)

The large number of plans in some places masks the fact that there aren’t that many insurers actually competing. In Miami-Dade County in Florida there are nine insurers selling 137 plans; Florida Blue alone offers 52 of them. Few markets are as competitive as is Miami. Nationwide, 18 percent of counties have only one insurer offering plans and 33 percent of counties have only two insurers competing, the KHN analysis found.

Monthly premiums are just one factor consumers will take into consideration when comparing plans. The data released by the federal government did not detail other crucial components of these plans, including deductibles, co-payments and which doctors and hospitals are in their networks. Consumers will have to turn to the insurers to find some of that information.

Price Differences Within Counties

Click On:


The analysis found that the most expensive plan in a county tended to be about double the cheapest plan. In some places it was even more. Policies in Miami-Dade County ranged from a Florida Blue plan that costs 30-year-old parents and two children $1,419 a month and covers 90 percent of average health costs, to CoventryOne’s HMO plan that would cost that same family $550 a month and include a high deductible.

Plans for a 27-year-old in Dallas ranged from $153 to $387 a month. That most expensive plan, sold by Aetna, will help pay some bills if a patient goes out of network. That policy is in the gold category, where the insurer is required to pick up 80 percent of medical costs. The cheapest Dallas plan, sold by Blue Cross Blue Shield of Texas, is an HMO in the bronze category, where it must pay for only 60 percent of medical costs.

The data show that prices vary significantly among policies grouped together in the same coverage tier. In Cook County, Ill., insurers offered 21 plans at the silver level, where insurers pay about 70 percent of the costs. Aetna is selling the most expensive silver plan in Cook County for $1,108 a month for a family, while Blue Cross Blue Shield of Illinois is selling the cheapest silver plan for $582 a month.

Names Offer Clues

The names insurers have given their plans hint how they hope to get an edge in these marketplaces. CoventryOne is selling “Bronze $10 Copay HMO.” Other plans include the annual deductible amount in their names to help differentiate them from each other.

Other insurers are seeking to tease the plan approach with less jargon-filled names. Molina Healthcare’s plans include “Be Protected,” “Be Prepared,” “Be Saavy,” “Be Aligned” and “Be Connected.” In Arizona, Meritus Mutual Health Partners is offering “Saver Choice Bronze” and “Lifestyle Choice Bronze” for the low-premium plans that require patients to pick up about 40 percent of the costs. Meritus’ most comprehensive plans are named “Smart Choice Gold” and “Clear Choice Gold.”

Outlier In Virginia

The premium data include some striking price outliers, especially in Virginia. There, the records say Optima Health’s silver-level premiums for a 27-year-old reach as high as an eye-popping $1,858 a month. Executives with the insurer, owned by hospital system Sentara, say those premiums are misleading because they include coverage for bariatric surgery, an expensive treatment for morbid obesity. Excluding those policies, the average Virginia silver plan was below the national rate.

“At the eleventh hour, the state allowed us to change that to a rider instead of a specific benefit,” said John DeGruttola, senior vice president of sales. Without the rider, the plan costs a 27-year-old $285 a month in those same counties.

Price Differences Across The Country


Raymond Smithberger, Cigna’s general manager for individual and family plans, said that medical costs can vary regionally because of differences in rates of disease, hospital charges and state-required benefits, among other factors.

“Similar to how the cost of living ranges in different parts of the U.S., so does the cost of health care,” he said.

Excluding the high-priced Virginia plans that covered bariatric surgery coverage, the average premium varied between parts of the country by as much as twofold. The average premium for a 27-year-old in Pierce County in western Wisconsin was $391; in Hidalgo County, Texas, it was $188.

The most expensive silver plan for a 27-year-old comes from Meritus in Arizona, a nonprofit co-op run by members. Its “Meritus Secure Silver PPO” runs $469 a month in some rural counties, according to the government data.

Jean Tkachyk, chief operations officer at Meritus, said the insurer has decided not to actively market those plans in those rural counties because “they would not be competitively priced.” In Phoenix and Tucson, Meritus was able to offer lower premiums because it was easier to get doctors and hospitals to join its network, she said. Meritus will be actively selling its plans there.

The lowest-priced silver plan in the country is in Pittsburgh, Pa., where a Highmark plan that excludes some area doctors and hospitals is being sold for $134 a month for a 27-year-old. Like many insurers, Highmark has created a smaller network to help hold down premiums. The $134 a month plan, for example, uses Highmark’s Community Blue Network, which has 8,000 doctors and 54 hospitals, compared with a broader network of 11,000 doctors and 63 hospitals that Highmark offers in more expensive plans.

Absent from the Blue network is the well-known University of Pittsburgh Medical Center, the main rival in the Pittsburgh region to Highmark’s own Allegheny Health Network. Highmark’s selective network “is generally more efficient, high quality and lower cost,” said spokeswoman Kristin Ash. A similar policy with the broader network including UPMC would cost $197 a month, she said.

— Jordan Rau and Julie Appleby, Kaiser Health News

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10 Responses for “A Confederacy of Choices: Marketplace Plans Vary Widely In Costs, In Counties And Across U.S.”

  1. Reaganomicon says:

    Gotta say, this is ridiculous because it does nothing about the root of the problem, which is skyrocketing prices for procedures that have no business being expensive. In india, they have floating hospitals that can do many medical procedures for little to no cost, e.g. $100 for cataracts, but at a bronze %60 paid plan that would still cost close to $4000 for someone in the US not including their monthly premium. I guess the lesson here is that someone in india that makes their living digging through trash has better health care than the average poor person in the US.

  2. Diego Miller says:

    None of the plans have the good benefits that are available with the company based health care plans. Most Doctors will not take Medicare or these newer plans. Your stuck with second rate doctors who dodge law suits and still practice. Also unlike the job related insurance plans you get no help with dental or vision whatsoever.. Psychiatric or Therapeutic coverage is out of the question.

  3. Gia says:

    Only a national universal care is the answer. That the way it work in other country’s.

  4. rhweir says:

    My preference would have been a simple expansion of Medicaid Managed Care combined with share of cost. Capitate them and let the managed care plans bear the risk and share the rewards. Medicaid Managed Care plans have reinsurance and they already have the bureaucracy in place. They know how to spread the risk and still profit or go out of business trying. Instead, we have a whole new bureaucracy and the risk involved for the insurance companies is causing premiums to go up in some areas. Not to mention, limiting what kind of plan people can chose and confusing provider panels. Good job, Obama, one of the reasons why I am now an independent voter after 43 years as a democrat.

  5. Liana G says:

    I just checked out my state’s (NY) Health Insurance Marketplace and discovered that the cheapest plan, the bronze, will actually cost our family more than we are currently paying via our employment plan, even with qualifying subsidies. The offers vary from $700 – $1,500. I didn’t even bother to look at the deductibles and other out of pocket expenses, since being the cheapest plan it is bound to be bare bones. Where is the freaking affordability in this AFFORDABLE CARE? Confederacy of choices my foot! This is designed for a confederacy of DUNCES!!!!

  6. BIG JOHN says:

    The Tea Party opponents of ACA are neo-Confederate racists who hate any govt program that helps out those who aren’t rich!!

  7. Sherry Epley says:

    Please remember, President Obama is NOT to blame for forcing the ACA through the private “for profit” insurance companies and the different rates in different states. President Obama absolutely wanted to offer a “public option” similar to Medicare. . . BUT the Republicans in Congress simply would not allow it.

  8. Freddy says:

    For those of you that defend Obamacare including Pierre Tristan why don’t you give us examples of people you know that is saving on this plan or examples of those poor souls who could not afford insurance before that are now able to buy affordable insurance.

  9. The Truth says:

    Those of you who are saying that these plans cost more than your company plans, what did you expect? Company plans are ALWAYS going to be the best option. The marketplace plans are geared towards those who are uninsured, don’t have a group option through their employer or those who are self employed. Insurance companies take advantage of you when you aren’t part of a group plan. The purpose of these plans is to essentially give more power to those who are in the marketplace buying insurance on their own.

    This isn’t a perfect solution, but it’s a step in the right direction. Universal health care is the answer and our health insurance/medical costs will continue to sky rocket until that happens. We are the richest nation in the world and our healthcare is not affordable to so many thanks to greedy pharmaceutical companies and insurance companies.

  10. Sherry Epley says:

    For those who need examples of how the ACA has already helped people have better health care, please read the posts of Nancy N on this site.

    There are many, many examples of how the ACA improves health care and stops massive discrimination by insurance companies. . . it took me 30 second to find this one. . . this is if one is really interested in looking past FOX. This from the Washington Post:

    “A lot of women — about 21 million according to estimates from a report on “The State of Women in America” from the Center for American Progress — don’t have insurance.

    So, exactly how do women benefit from Obamacare?

    First, the Affordable Care Act eliminates the discrimination that women have faced when buying insurance. For years, insurance companies may have charged women up to ten times more for their insurance than they charged men. Women often were denied coverage because of a “pre-existing” condition. As Senator Barbara Mikulski, Democrat of Maryland, recently said, ”Maternity was considered a pre-existing condition. In some instances, if you’d had a premature birth or a C-section, you were denied coverage, because it was a pre-existing condition. In eight states, if you were a victim of domestic violence, that was counted as a pre-existing condition and you couldn’t get access to healthcare.”

    Under Obamacare, insurance companies can no longer use gender as a factor when setting premiums.”

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