The wait is over: People who want to buy health insurance on the state’s Obamacare exchange can go online to see their options and prices, but they may not like what they find.
The plans unveiled online Monday contain far fewer choices and significantly higher prices, and arrive toward the end of a presidential campaign in which Republican candidate Donald Trump has called for the repeal of the Affordable Care Act and Democratic candidate Hillary Clinton has said she wants to fix it.
President Barack Obama recently defended the law under which the exchanges were created — the Patient Protection and Affordable Care Act — while conceding it’s not perfect. On Monday, administration officials insisted that coverage on the exchange will still be affordable for most Americans.
Most Illinois residents get health care coverage through their employers or government programs such as Medicare or Medicaid. But this year, more than 300,000 Illinoisans bought insurance on the Obamacare exchange.
Consumers can begin signing up for plans on the exchange Nov. 1.
In Illinois, rates will increase by an average of 44 percent for the lowest-priced individual bronze plans, 45 percent for the lowest-priced silver plans and 55 percent for the lowest-priced gold plans. Higher-level plans, such as gold plans, typically have higher monthly costs and lower out-of-pocket costs than lower-level plans.
In Illinois, a 27-year-old who buys the second-lowest price silver plan on the exchange will pay an average of $298 a month before tax credits — a 43 percent increase over this year. A family of four in Illinois will pay an average of $1,078 a month for the second-lowest price silver plan before tax credits.
There are also far fewer plans to compare. In Cook County, individual consumers will have 38 plans to choose from, down from 71 plans this year. In Lake County, there are 18 plans, down from 49 this year. McHenry County went from 42 plans to 14, DuPage from 48 to 34 and Kane from 48 to 25.
The federal government, however, says with the help of tax credits, 60 percent of Illinois residents who buy on the exchange will still be able to choose plans costing no more than $100 a month.
“The Affordable Care Act was designed with price-sensitive consumers in mind,” Aviva Aron-Dine, senior counselor to the U.S. Secretary of Health & Human Services, said in a call with reporters Monday. “It was designed to protect them, and this year, just like in previous years, that’s what it will do.”
But many consumers still will have to make difficult choices.
Highland Park cancer survivor Michelle Applebaum said she’s having trouble finding a PPO plan on the exchange that includes her oncologist and her primary care doctor. She wants a PPO plan so she can still cover two children in their early 20s who live out-of-state. HMO plans don’t have an out-of-network option.
Only one insurer, Blue Cross and Blue Shield, is offering PPO plans on the Illinois exchange next year, down from five this year. Blue Cross’ networks for its PPO plans are largely the same as they were this year, spokeswoman Colleen Miller said.
“I don’t mind paying more,” said Applebaum, who owns a consulting business. “I mind not being able to see my doctors and insure my children.”
Miller said Blue Cross and Blue Shield of Illinois set networks and prices the way it did this year in hopes of helping to stabilize the market for the long term. Many of the insurers that left the exchange cited financial struggles as their reason for exiting.
In some parts of Illinois, deductibles range from about $1,000 to more than $7,000, depending on the type of plan and the county. A deductible is the amount a consumer must pay toward health care costs in a year before the insurance starts covering many expenses.
Frank Vance, a former president of the Chicago Southland Association of Health Underwriters, said people ultimately will pay higher prices for the hospitals and doctors they need.
“The days of going wherever you wanted to go are gone, and you’re basically having to be selective with whatever plan you choose,” said Vance, owner of EganVance Insurance in Chicago.
Stephani Becker, a senior policy specialist at the Sargent Shriver National Center on Poverty Law, said Illinois residents’ experiences shopping on the exchange will depend on their income levels and where they live. People who qualify for subsidies, for example, won’t feel the full effect of the price increases. This year, 75 percent of Illinois residents who bought coverage on the exchange got the tax credits.
“I would agree we need to make some fixes in terms of affordability but the fact that these options are available to so many people is a very positive thing,” Becker said.
Kathy Waligora, director of the health reform initiative of EverThrive Illinois, said it’s important for consumers to take advantage of online tools and free in-person help, offered through the exchange. On healthcare.gov, individuals can enter their income levels to see how much plans might cost after tax credits and their preferred hospitals and doctors to see if they’re in-network on each plan.
The Obama administration expects another 1.1 million people nationwide to buy insurance on the exchanges for next year, bringing the total up to 13.8 million.
lschencker@chicagotribune.com
Twitter @lschencker
