How Affordable Are Affordable Care Act Options?

Oct 3, 2013

That depends.

If you're uninsured or the health insurance your employer offers costs more than 9.5% of your income, you can now shop for a plan on Rhode Island's newly launched That's the Ocean State's version of the online marketplaces now open for business across the country under the Affordable Care Act, or Obamacare.

You plug in your age and income, and the site pulls up your options: a list of plans, what they'll cost you each month, whether your current doctor accepts that particular plan, and other details you'll want to consider before buying. Among those details: the plan's deductible and out-of-pocket costs. (The deductible is how much you have to pay before insurance kicks in. The out-of-pocket costs are the portion you continue to pay even after insurance kicks in [for example, some insurance plans cover 80% of a hospital stay after you've met your deductible, which means you're responsible for 20%].)

You might be able to afford the monthly premium, if you earn enough money or you qualify for a tax credit. But the deductibles and out-of-pocket costs might still bust your budget. $5000 - $5800...that's the deductible range for plans I looked at.

It's not so surprising. Health care costs are going up for almost everyone. Those of us lucky enough to have insurance have most likely seen our deductibles and possibly our premiums go up. And despite the promise of its title, the Affordable Care Act may not do much to lower those costs - for a while. The hope is that plenty of young, healthy folks will sign up for health insurance plans and help lower costs for everyone by spreading out the risk. There are other efforts to lower costs. But they'll all take time.

Meanwhile, is there any help for those who can't afford those deductibles and out-of-pocket costs?

Yes, for some. Besides the federal premium subsidies (a tax credit that goes directly toward the premium and not into your pocket, by the way) for people making up to 400% of the FPL, there's a state program to help with out-of-pocket costs. A contact at the Rhode Island Health Coverage Project told me it's designed to help people who make up to 250% of the FPL. There's more assistance for those who qualify for RItecare, Rhode Island's Medicaid program. But the state recently changed eligibility rules and more than 7,000 families will be taken off the rolls. The idea is that they'll buy insurance on the exchange if they don't receive it through an employer. But whether they'll be able to afford the premiums, deductibles, or out-of-pocket costs remains to be seen.