Some Obamacare Customers See Sharp Climb For Deductibles

March 01--Deductibles are going to get even higher for some Connecticut residents covered under Obamacare after the Access Health CT board voted Tuesday for a rate increase.

Deductibles will increase 25 percent to $5,000 for customers with standard silver plans whose income is too high to qualify for cost-sharing. That change will affect 16 percent of the roughly 110,000 customers.

A total of 8.5 percent of customers will see their deductibles increase to $4,700, 15.5 percent will rise to $750 and 14 percent will remain without a deductible.

Unlike many insurance plans, Obamacare deductibles in silver plans do not apply to most services, and there's a separate, much lower deductible for prescriptions. Physical therapy, radiology, doctors' visits all have co-pays, but do not require those with plans to meet the deductible before paying.

However, starting in 2018, some of the customers will have to pay for emergency room visits out of pocket.

The board had to make these changes because the law sets guidelines for how much insurers spend compared to how much they are paid in premiums. The insurers have been spending more than their share, so costs needed to be shifted to consumers.

Connecticut Insurance Department Chief Actuary Paul Lombardo said that in the most recent news from Anthem and ConnectiCare, they are spending about 95 percent of premium revenue on claims. That doesn't leave enough for marketing and administrative costs, much less profits.

Board Member Grant Ritter, who said he didn't like having to make some of the changes, said that making more customers have to pay for emergency room visits if they haven't met their annual deductibles was "the one thing that could really move the dial down."

Vicki Veltri, chief health care adviser to the lieutenant governor, said she's concerned that people don't understand that when they choose Bronze plans, those come with a $6,000 deductible, and only primary care visits or urgent care visits get covered before the deductible is met.

Access Health CT CEO Jim Wadleigh said the customers' confusion about health insurance is far greater than not understanding the trade-off between premiums and deductibles.

"All in all, they don't know what they're buying," he said, and noted that some of the customers in focus groups didn't even understand that you have to pay a monthly premium to keep the policy active.

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