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Tuesday, October 1, 2013 - 4:09pm

It’s All About Location For Health Insurance Exchanges

The health insurance exchanges for the Affordable Care Act are now underway. There are 1.9 million people who are uninsured in Georgia, and 800 thousand are eligible for subsidies. Kaiser Health News reports rates across Georgia have the biggest variation in the country, with southwest Georgia seeing the highest premiums in the state.

Andy Miller is CEO and Editor of Georgia Health News, a non-profit news organization that focuses on healthcare in Georgia. He says price differences by region can be quite significant. “If you’re a 21 year old, looking for the cheapest Silver Plan in the southwest area that includes Albany, it’s going to cost you $360 a month for your premium. Whereas in Atlanta and two other regions it’s going to be half that, $179 for the same plan for the 21 year old.”

One of the reasons is competition. In metro Atlanta, there are a number of insurance companies offering plans. In southwest Georgia, only Blue Cross and Blue Shield of Georgia is offering the plans. And while metro Atlanta has several different hospital systems to choose from, in southwest Georgia, Phoebe Putney is the dominant player. The hospital purchased the other major provider, Palmyra Medical Center. In August the Federal Trade Commission reached a settlement that allows Phoebe Putney to keep Palmyra.

But Blue Cross and Phoebe Putney executives say that’s not the only reason rates are higher in southwest Georgia. Another significant factor is demographics. They say the rural area has a higher percentage of residents with chronic diseases. Because the area has more low-income residents who haven’t been able to afford preventive care, they are more likely to wait to get medical treatment. And that means they are often sicker, with higher medical expenses.

Dr. Joseph Stubbs, an internist in Albany, is concerned that his patients won’t sign up for the new health insurance exchanges because of the higher costs.

But Andy Miller says low-income residents are eligible for subsidies and tax credits that will drop the cost significantly. He says “If you don’t have insurance right now, or if you are buying insurance by yourself or with your family and if you don’t have employer-based coverage, those are the folks that should definitely check this out.”

Miller stresses that someone who is making between 100 percent of the federal poverty level and 400 percent, is eligible for subsidies and tax credits which will drive their premiums lower. “In fact, some people will get it for under $100 a month.” he says.

The rates are based on a variety of factors including your age, older people will pay more, whether you smoke or use tobacco products, and where you live.

Miller warns you shouldn’t base your decision on which plan to get solely based on how much the monthly premium will cost. You also need to consider deductibles and co-pays. He says some plans have deductibles of $5000. But Miller stresses that’s not necessarily bad. If you are a healthy young adult who doesn’t have chronic health issues and only goes to the doctor once a year, such a plan may make sense.

He adds you also need to check and make sure your doctor is in the plan you are considering, and make sure your prescriptions are covered by any plan you are considering.


Andy Miller, Georgia Health News

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