The Daily Item, Sunbury, PA

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September 25, 2013

"Is my spouse covered?" and other questions about the new health-care law


Q: Just to confirm: These plans aren't priced based on weight, correct? This is currently a pre-existing condition, and a friend of mine who's overweight but not obese couldn't get coverage for that reason — and for age reasons.

A: You cannot be denied coverage based on a pre-existing medical condition or your age. Insurers do have some latitude to charge an older person more than a younger person, but it's limited. Insurers can charge an older person no more than three times what they would charge a younger person for the same policy.

Q: Will plans be allowed to charge more to someone in poor health than someone with no health problems, assuming they are same age and sex?

A: No. Starting Jan. 1, plans can vary premiums based only on age, where you live, whether you smoke and family size.

Q: My question is about deductibles: Will these be set at a standard dollar figure that is the same for all plans (or all "silver" plans, let's say), or do they vary from one plan offering and insurer to another? I have bought individual insurance for many years. When I turned 50, I had to increase my deductible from $500 a year to $2,500 so I could still afford coverage. The practical result: When I had chest pains for the first time in my life earlier this year, I did not go to the ER because I figured it would cost me thousands of dollars even though I'm "insured." Needless to say, I would love to find a plan now with a lower deductible (more like $500 than $2,500), so it's more like real health insurance again. Will that be a possibility?

A: The quick answer is that deductibles will vary. Generally, plans in the "gold" and "platinum" tiers will have lower deductibles than those in the "bronze" and "silver" tiers. All plans will have a cap on annual out-of-pocket costs, which include the deductible and other cost-sharing, such as co-payments for doctor or hospital visits, to a maximum of about $6,350 for individual policies or $12,700 for family plans, in 2014. Those amounts are lower than about one-third of plans currently offered consumers on the individual market, although consumer groups say that some families will still struggle.

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