A brief primer on selecting health care policy under Obamacare

October 11, 2013 

Kimberly Durocher took special training to help the uninsured enroll in the new federal health insurance program, and she assists people at one of the Manatee County Rural Health Services enrollment sites. SARA KENNEDY/Bradenton Herald

As computer wizards work to overhaul the online health insurance marketplace, plagued by crashes and delays since opening last week, uninsured Americans still clamor for policies. HealthCare.gov got swamped with seven million visits in just the first two days of balky operation. But those computer issues will be resolved.

The more difficult task for consumers is selecting the best option for their circumstances. Within the different levels of insurance plans -- labeled bronze, silver, golf and platinum -- policies vary widely in cost and coverage. Get educated before signing up.

But there is much to like (ù) and dislike (÷) about the Patient Protection and Affordable Care Act. To wit:

ù The average premium nationally for the second lowest cost silver plan is $328 before tax credits, which is 16 percent lower than projections. In Florida, that average is lower still, at $304.

When considering all the levels and plans offered in Florida, the average cost for a 27-year-old individual comes to $264.45 per month.

But Manatee County residents will pay even less, at $258.01. On average, Manatee individuals and families will pay less than residents in the state's other 66 counties.

Remember, though, lower premiums come with higher out-of-pocket expenses.

Generally, under bronze plans, consumers will pay 40 percent of their health care bill while the policy covers 60 percent. Policyholder costs are 30 percent under a silver plan, 20 percent with gold and 10 percent with platinum.

ù All of this is before taking into account federal financial assistance via tax credits, the exact figure depending on consumer income.

Americans earning between 100 percent and 400 percent of the federal poverty level ($11,490 to $45,960 this year) could be eligible for subsidies, including about half of Florida's 3.5 million uninsured residents.

Tax credits can be employed monthly to help pay for policies.

÷ About a million Florida residents are too poor to qualify for subsidies but cannot get Medicaid either since the state Legislature continues to refuse to expand eligibility under Obamacare -- a shameful political position.

Those low-income residents will be left with seeking free care at emergency rooms and community clinics but will not face fines under certain exemptions.

ù Manatee County residents shopping for coverage will discover 69 policy choices sold by four insurers.

With an average of 102 plans, Florida has one of the highest number of choices on the state's federally operated insurance exchange.

÷ Some coverage is limited to specific hospitals and doctors within a network. Pick your policy carefully to avoid out-of-network -- and out-of-pocket -- expenses, and to keep your current physician.

ù With so many coverage tiers and policies within those plan levels, consumers will no doubt encounter confusion and frustration, but fortunately there are enrollment counselors -- also called navigators -- to provide assistance.

Manatee County Rural Health Services offers eight enrollment sites scattered around the county, from Bradenton and Palmetto to Parrish and Myakka. Call 855-253-9098 with questions or to make an appointment, or email marketplace@mcrhs.org.

÷ Unfortunately, Gov. Rick Scott's strong opposition to Obamacare extends to navigators, and state policy forbids county health departments from allowing the counselors on their properties -- a disservice to Floridians. The Manatee County Health Department is abiding by this callous policy.

Open enrollment for policies effective Jan. 1, 2014 continues through Dec. 15. There's lots of time left to explore options before selecting coverage.

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