Coventry premiums lower on health marketplace

10/12/2013 8:18 AM

08/08/2014 10:19 AM

New tools and information on health care websites show that for area residents, most of Coventry’s plans on the marketplace will have lower monthly premiums than those offered by Blue Cross Blue Shield of Kansas.

The rate estimates, which are listed before income-based calculations of tax credits and government subsidies, are found at www.healthcare.gov/find-premium-estimates/.

So far, that portion of the site is the only place to find rates associated with companies and specific plans because of widespread issues that have plagued the new federal marketplace since it launched Oct. 1.

In the information provided at the estimate site, for example, Sedgwick County residents seeking coverage for themselves and a spouse can expect to pay for silver level Coventry plans that range from $395 to $447 a month. The silver plans under Blue Cross start at $460 and go up to $549.

However, consumers still can’t get age-specific information for most plans, so it doesn’t appear that shoppers could get answers about how much plans would cost them.

Asked about the differential in the prices on the site, Blue Cross Blue Shield of Kansas spokeswoman Mary Beth Chambers said insurers are planning for many of the new customers on the marketplace to have existing health conditions, a factor that cannot be used by insurance companies in determining rates or risk.

“In this new environment, it is likely that different insurers will make different assumptions about these market changes, creating variation in the costs that consumers see,” Chambers said in an e-mail.

“For the next few years, there will be much uncertainty in the health insurance industry as individual insurers predict how to price their products competitively and with the assurance that they will collect the dollars needed to pay for the medical care required by the expected influx of new consumers.”

Consumers also should make sure they’re comparing apples-to-apples when shopping for plans, Chambers said.

“Before purchasing any plan, a consumer should check to see if they would have in-access network to the doctors, hospitals and other health care providers that they use; if they must have a referral to see a specialist; if the prescription drugs they use are covered in the formulary; and, the insurer's reputation for providing customer service and processing claims,” she said.

Officials at the regional Centers for Medicare and Medicaid Services office in Kansas City were not available for questions about the website because many have been furloughed as part of the federal government shutdown.

Representatives from Coventry did not respond to requests for information or comment.

What’s included

All plans on the marketplace will have to include certain “essential health benefits,” that will have varying amounts for out-of-pockets costs and premiums.

When open enrollment in the online marketplace works, there will be four regular plans – bronze, silver, gold and platinum – that have different levels of premiums and out-of-pocket costs associated with them, but all have to cover “essential health benefits,” including emergency services, hospitalization, maternity and newborn care, mental health and substance-use disorder services, prescription drugs, laboratory services, preventive and wellness services, chronic disease management and pediatric services, as well as oral and vision care.

There will also be a catastrophic plan with lower premiums and variable out-of-pocket costs that will be available for people ages 21 to 30.

The only platinum plans that are available in Sedgwick County are through Blue Cross and Blue Shield.

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