Study: Finding the Best Value For Individual Coverage Under Obamacare in Major Cities
After collecting data for nationwide individual health insurance plans under Obamacare, known as “qualified health plans,” we reviewed the results to find the cities offering the most affordable gold plans. Gold-level plans cover 80 percent of medical costs, leaving the policyholder responsible for 20 percent.
With lower, or sometimes no deductibles, gold plans offer copays for various services, including office visits with primary care physicians and specialists, hospital care, prescriptions and more. You can’t find this sort of coverage with bronze and silver plans, as their premiums are lower, deductibles are higher, and coverage is considerably less.
For this study, we ran quotes for 30-year-old, non-smoking residents in 50 of the nation’s densest cities. Additionally, we tried to find plans with a deductible around $2000, which wasn’t always available in certain markets.
We made sure each plan on our list included copays for office visits, prescriptions, and preferably other services such as emergency care — all the makings for a worthwhile policy. It was refreshing to see that on the gold level, copays for numerous services are offered on plans in most every major city we surveyed.
Our results showed a far different look to the individual market under the Affordable Care Act from last year’s survey of private health plan premiums.
Why Gold Plans?
In previous studies, we’ve looked for the best buys on comprehensive plans. Plans that cover what you need them to, and don’t leave you on the hook for a huge bill when you receive care.
One of the biggest mistakes people make when buying health insurance is settling on what they think is the cheapest plan by looking at the monthly premium. In terms of the health law’s qualified health plan tiers, this comes in on the bronze or silver level.
These plans come with high deductibles, and often coverage that doesn’t even start until you meet that, say, $5000 deductible. Essentially, you’re uninsured until you pay for $5000 worth of care. Doesn’t seem so cheap anymore, does it?
On the gold level, insurers are required to cover 80 percent of costs, so they’re more apt to let you pay a flat $20 to see the doctor, or $100 to go to the hospital. Most people prefer this predictable structure to wondering how much they’ll have to pay for healthcare.
Because of their design, gold plans are the best value available on the individual market, if you’re considering qualified health plans (QHPs) under the ACA. QHPs are a product of the health law, establishing a few basic guidelines for insurers to follow in order to provide fair coverage.
Results: Most Affordable Gold Plans in the 50 Biggest Cities
|8||Portland, OR||$215||Health Net||$1300|
|13||Long Beach, CA||$224||Health Net||$0|
|14||El Paso, TX||$226||BCBSTX||$1500|
|15||Las Vegas, NV||$235||Health Plan of Nevada||$1000|
|17||Los Angeles, CA||$245||Health Net||$0|
|20||San Antonio, TX||$249||Humana||$2500|
|21||Colorado Springs, CO||$252||Humana||$2500|
|27||Kansas City, MO||$263||CoventryOne||$1750|
|28||Oklahoma City, OK||$264||BCBSOK||$1000|
|29||Philadelphia, PA||$267||Independence Blue Cross||$0|
|31||San Diego, CA||$272||HealthNet||$0|
|35||Virginia Beach, VA||$289||Optima Health||$1000|
|37||Fresno, CA||$295||Blue Shield of California||$0|
|38||Fort Worth, TX||$296||BCBSTX||$1000|
|40||Seattle, WA||$308||Premera Blue Cross||$1500|
|41||Oakland, CA||$331||Blue Shield of California||$0|
|42||Boston, MA||$332||Fallon Community Health Plan||$2000|
|43||Sacramento, CA||$347||Blue Shield of California||$0|
|45||San Jose, CA||$364||Anthem Blue Cross||$0|
|47||San Francisco, CA||$390||Blue Shield of California||$0|
|49||Indianapolis, IN||$419||Anthem BlueCross BlueShield||$1000|
|50||New York, NY||$519||Empire BCBS||$1000|
Of the 50 largest cities, the best price for a solid plan was found in Minneapolis, Minnesota, a state that implemented statewide health reform efforts even before the ACA. The most reasonable gold plan in the city cost $157 per month from PreferredOne, a regional carrier in the Midwest.
With a $2000 deductible and copays for the majority of services an average 30-year-old applicant might need, this individual policy shows that plans off the exchange can provide excellent value, even without subsidies. It just depends on where you live.
New York City remains the most expensive major city for health insurance premiums at $519 per month. It’s difficult to imagine many people would be able to afford this coverage, even if their income is too high for the premium tax credit on the exchange.
The private market in Texas is one of the more reasonable ones under the health law, and Louisville, Kentucky remains an inexpensive city for individual plans even after the ACA’s implementation.