Obamacare Focus Should Be Total Cost Not Monthly Premium, Experts Warn

State & Regional

January 31 marks the end of the open enrollment period for Texas residents who want to sign up for health insurance through the Affordable Care Act.

According to the U.S. Department of Health and Human Services, nearly 1.1 million Texans have signed up for health insurance through the ACA’s federal exchange, and 8.5 million people have signed up nationally.

“Last year we saw about 1.2 million sign up by the whole end of the open enrollment period,” Melissa McChesney, Outreach Coordinator at the Center for Public Policy Priorities said. “So, I think we are certainly on track to exceed the number that signed up last year, and the tax penalties certainly play a role in that.”

According to the Kaiser Family Foundation, this year the average tax penalty will rise to $969 per household that chooses to remain uninsured or 2.5 percent of your family income, whichever is higher.

McChesney said the most common mistake people make is choosing the plan with the lowest premium.

“What is important is that they find the plan that works best for them,” McChesney said, “and it is not always going to be the cheapest plan when it comes to how much they pay per month.”

McChesney said her biggest piece of advice is to remind customers that everyone is different. So, while one plan might be the best option for one customer, it is not necessarily the best plan for the next person.

“A person with a chronic illness, their most important thing may not be cost. It may be that they can go to the hospital if they want to, or the doctor that they want to, or that they have their prescription medicine covered in a way that they want to,” McChesney said. “So, they may be more likely to choose a plan that addresses those things, rather than just a plan that has the cheapest premium per month.”

“You should really focus on the total out of pocket cost that you are likely to incur, which includes not only the premium that you pay, but also the deductible, the co-payments, a coinsurance for prescription drugs and services, and you need to look at the out of pocket maximum,” Lehmann Li, CEO and creator of Savue.com said. “Different plans could make you liable for higher amounts during the course of the year. These other factors aside from premium could easily add thousands of dollars to your total out of pocket cost.”

Lehmann Li created the website Savue.com where shoppers can input their exact medication and dosage to make sure they choose the cheapest plan that also fits their needs.

“Especially for Texans who have one of these major chronic diseases of diabetes, hypertension, and high cholesterol, because you wind up paying for prescription drugs, medical services, other health care costs,” Li said. “That’s what we do. We automatically identify all the kinds of programs that can reduce the out of pocket cost for the patient or the household.”

People who wait until January 31 will not actually start coverage until March. For coverage in February, the deadline to sign up is January 15.

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