Cost, coverage details revealed for health care exchange

In an hour-and-a-half briefing Tuesday, Christine Ferguson, the executive director of HealthSourceRI, offered the first details of the 28 different health insurance plans to be offered – 12 for individuals and 16 for small businesses with fewer than 50 employees – beginning Oct. 1. More

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Health Insurance

Cost, coverage details revealed for health care exchange

INSURANCE PLAN DETAILS for HealthSourceRI, Rhode Island's new health insurance exchange, were released.
Posted 8/20/13

Updated: 4:00 p.m.

PROVIDENCE – In an hour-and-a-half briefing Tuesday, Christine Ferguson, the executive director of HealthSourceRI, offered the first details of the 28 different health insurance plans to be offered – 12 for individuals and 16 for small businesses with fewer than 50 employees – beginning Oct. 1.

Ferguson distributed two tabloid-sized charts with transparent, precise details: the health insurer offering the plans; the network type; services; preventive services and screenings; deductibles and co-insurance and co-payments for ER visits, lab services, high-end imaging and primary care and prescription drugs.

In addition, Ferguson also offered two charts breaking down the costs per month for premiums according to age for each of the 28 plans offered.

No other state, Ferguson said, is providing this kind of detail, enabling consumers to make comparisons not just on premiums but on the overall cost of health care services.

For instance, the charts show that in the individual market, under the “gold” version of Blue Cross & Blue Shield of Rhode Island’s Vantage Blue SelectRI Direct 500/1000 plan, the monthly premium is $282 for a 24-year-old, $408 for a 45-year-old, and $793 for a 61-year-old. The deductible is $500 for an individual and $1,000 for a family. The provider network is a Preferred Provider Organization, or PPO, with tiers. The maximum out of pocket expense in a give year is $4,000 for an individual and $8,000 for a family, including co-payments and coinsurance.

By comparison, in the individual market, the “gold” version of Neighborhood Health Plan of Rhode Island’s “Plus” plan, the monthly plan is $269 for a 24-year-old, $389 for a 45-year-old, and $757 for a 61-year-old. The deductible is $2,000 for an individual and $4,000 for a family, with an additional drug deductible of $100 for an individual and $200 for a family. The provider network is a health maintenance organization, and the maximum out-of-pocket expenses are $4,000 for an individual and $8,000 for a family. The Neighborhood plans are being offered to individuals with incomes below $28,275 for an individual and families of four with incomes below $48,825 – 250 percent of the federal poverty level.

The actual costs of the plans may be reduced by tax credits for those who make less than 400 percent of the federal poverty level – $45,960 for an individual and $94,200 for a family of four.

The materials will be available in draft form as a PDF on the HealthSourceRI website.

On the small business side, employers with fewer than 50 employees will be able to offer “full employee choice” to their employees. Once the employee selects a plan and contribution level that best fits the budget, employees can then shop for the best benefit package that suits their needs, according to Ferguson.

“The bet is that people in Rhode Island are not stupid,” Ferguson said, and that they will be able to figure out the best package when looking at prices for health insurance, considering premiums, how care is delivered, services, deductibles, co-insuance and co-payments.

The other advantage, Ferguson stressed, is that the HealthSourceRI call center will serve as an information hub for all Rhode Islanders, answering questions and providing accurate information.

Ferguson also said that briefings are planned with insurance brokers. “About 80 percent of the small business market in Rhode Island is controlled by about 18 brokers,” said Ferguson, who has set up a brokers’ advisory committee.

“Small business participation is absolutely essential,” she said. “If employers see the value of this, I think you’ll see faster changes in the health care system.”

Feguson’s expectation is that there will be more innovative products on the market in the second year of operation beginning Jan. 1, 2015, including Tufts Health Plan and a number of network plans that include hospitals, insurers and group medical practices.

In terms of numbers, Ferguson defined the small business marketplace as having about 157,000 employees in firms with fewer than 50 employees. Using a 1.9 multiplier for family members, the total market is about 300,000, she said.

An estimated 70,000 to 100,000 Rhode Islanders will buy health insurance on the new market, according to Ferguson, by the end of December 2014.

Links to the HealthSourceRI plan charts are below:

Listing of approved individual plan rates by age and tier

Note: Approved individual plan rates do not factor in additional tax credits for which many Rhode Islanders may qualify. Individuals with incomes below 400 percent of the federal poverty level ($45,960 for individuals and $94,200 for a family of four) may qualify for tax credits to make their monthly insurance premiums more affordable. Tax credit calculators are available on HealthSourceRI.com to help individuals, families and small businesses understand what credits they may be eligible to receive.

Listing, by tier, of individual plan details, including network type, deductibles and out-of-pocket expenses

Listing of approved SHOP plan rates by age and tier

Listing, by tier, of SHOP plan details, including network type, deductibles and out-of-pocket expenses

Updated to include detailed charts.

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