NC officials approve 67 subsidized health plans

jmurawski@newsobserver.comAugust 1, 2013 

North Carolina insurance regulators said Thursday that they approved 67 insurance plans to be offered in the state this year with federal subsidies as part of the nation’s health care law, the Patient Protection and Affordable Care Act.

The N.C. Department of Insurance provided a list of all approved plans a day after saying the information was a trade secret and could not be disclosed. The subsidized policies are designed for more than 1 million North Carolina residents who don’t get coverage through their employer, Medicare or Medicaid.

The disclosure offers a glimpse of what the state’s health care universe will look like under Obamacare but doesn’t help the uninsured with planning and budgeting. The rates and other details of the proposed plans remain under seal as trade secrets and are not expected to become public until enrollment begins Oct. 1.

All 67 plans still require certification from the U.S. Department of Health and Human Services before they can be sold. For that reason alone, disclosing the rates now could confuse the public, said Adam Linker, a policy analyst at the N.C. Justice Center.

“If the feds cut the rates or make other changes, you would not get the true rate if you released the information now,” Linker said. “Because only a few providers are offering plans, I wouldn’t want them to see each other’s rates, conclude they’re not competitive, and pull out of the state.”

What is clear from the filings, however, is that many North Carolina residents will have a limited choice of just a handful of plans, depending on where they live and on the health care networks available in their area. Premiums, co-pays and deductibles will vary by county or by region, and they will also vary by the level of medical costs they cover.

Blue Cross, which plans to offer 26 plans, is the only insurer that plans to offer subsidized coverage in all 100 counties of the state. Coventry Health Care of the Carolinas, offering 25 plans, is expected to operate in major metropolitan areas.

A third provider, FirstCarolina, will operate in just six counties: Lee, Moore, Richmond, Hoke, Montgomery and Scotland. FirstCarolina has submitted 16 plans.

“There are differences according to county as they differ in terms of access to providers and other health services,” said Blue Cross spokesman Lew Borman. He said geographical price differences have been in place for years in the insurance industry.

Blue Cross rates cut

The reaction to the nation’s switch to subsidized insurance has played out differently across the country. Coventry announced this week that it is pulling out of Georgia, but company spokesman Walt Cherniak said it doesn’t plan to exit the North Carolina market.

Minnesota officials have pressed insurers to disclose plan details early so consumers have extra time to review their options. A number of states have decreased insurers’ proposed insurance rates, and Maryland insurance officials slashed rates by a third for the nine carriers planning to sell subsidized policies there.

The N.C. Department of Insurance also said Thursday that it cut rates proposed by Blue Cross and Blue Shield, the state’s largest insurer, by 10.2 percent. Rates proposed by Coventry Health Care of the Carolinas and FirstCarolinaCare were approved without changes.

Blue Cross has advised its customers that subsidized policies will cost more on average. One reason is that the policies have to meet federal minimum requirements and offer such essential health benefits as emergency services, maternity care, substance abuse services as well as preventive and wellness care.

Blue Cross also predicts that high numbers of people in poor health could buy coverage, driving up health care costs systemwide.

Four coverage levels

Coverage options will include a catastrophic plan and four coverage levels. Catastrophic coverage plans are designed for people under age 30 and those with very low incomes; they have large deductibles and cover just three primary care visits a year but provide a cushion against ruinous medical bills. Bronze plans will cover 60 percent of health care expenses, silver plans will cover 70 percent and gold 80 percent. The costliest coverage level, platinum, will cover 90 percent of medical expenses.

About 1.3 million residents, or 17 percent of the state’s population, are uninsured. Another 435,000 pay out of pocket for individual insurance, and many of those are expected to switch to subsidized insurance. Individuals and families with incomes up to 400 percent of the federal poverty level will qualify for subsidies on a sliding scale.

Officials in other states have said that the subsidized plans don’t resemble insurance products from past years. A main reason why is because of new federal bans on denying coverage to people with pre-existing conditions, on charging women more than men, and on charging exorbitant rates to older people.

“The difference this year is that there are only three factors in rating products to determine premiums: geographic location, age and tobacco use,” Borman said.

Murawski: 919-829-8932

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