The Department of Health and Human Services released data Friday on next year’s prices in the insurance markets established by the law. Returning customers to HealthCare.gov can save, on average, $51 a month if they switch to the lowest-cost plan within their coverage level, according to the report. Most can find a plan for $100 a month or less, after financial help from a tax credit.
To hear the administration tell it, there are deals galore. But experts say the monthly premium is only part of the story. They say consumers should examine the quality and coverage of health plans, as well as their prices.
The price message appeals to young uninsured Americans and will be stressed in advertising and enrollment drives this season as the administration tries to find, woo and keep 10 million paying customers by this time next year, a modest target announced earlier.
Beyond the sticker price, consumers should keep an eye on what they will get for their premium dollars, experts said. Shoppers should consider how many hospitals and doctors are covered, for example, and which prescription drugs are included.
“What the message should be is ‘be a smart shopper,’ ” said Caroline Pearson of Avalere Health, a private market analysis firm. “All we really see in this report is price, price, price. That’s what the government thinks will draw [consumers] to the market, but it may also be what disappoints them when they get sick.”
People do switch plans. In 2015, nearly a third of returning customers changed to a new plan on the marketplace. That’s a far higher rate of plan-switching than among people who get their coverage through a job, said HHS Assistant Secretary for Planning and Evaluation Richard Frank.
Some consumers are being forced into new plans because of plan cancellations and the collapse of some health insurance cooperatives. The data released Friday show a choice of 50 plans a county overall, compared to 58 a county last year, and an average decline of two plans per insurer.
“That’s not a change that concerns us,” Frank said, calling it a sign of a “maturing market” as insurers drop unpopular plans.
It will take more time to fully analyze how insurers have restructured health plans for 2016. In some markets, there are fewer “preferred provider organization” plans. Those PPO plans give consumers the most flexibility about which doctors they can see. Some counties have no PPO plans on the market for 2016, leaving customers with a choice of HMOs and other more limited types of policies.
“It means that generally the networks are smaller. … You can’t go to providers outside the network just because you want to without paying the full cost,” said Gary Claxton of the nonpartisan Kaiser Family Foundation.
The government plans to add tools to HealthCare.gov to make it easier for people to check if their doctor or a drug is covered in a plan. But those tools aren’t ready and are still being tested for accuracy.
The bottom line, said Claxton, is “do your own research.”