TONY WILSON: Rates but no plan details listed on health exchange

Without much fanfare — which is highly unusual for this administration when it comes to any positive spin it can put on the recent rollout of the health care exchange website — the Feds added an option on the exchange website to compare rates without having to create an account.

But, don’t pop the cork on the bubbly just yet.

The exchange — also referred to as the Federally Facilitated Marketplace (FFM) — is the centerpiece of the Patient Protection and Affordable Care Act (PPACA). The FFM is a web portal (www.healthcare.gov) that allows Georgians and residents in 35 other states another option when purchasing health insurance coverage.

Many people, including your humble correspondent, have tried (unsuccessfully) to log into the website over the past few weeks to see the plan designs offered and, more importantly, the rates.

A number of state-run exchanges around the country allow those interested to enter some basic data about themselves and any dependents, and those websites return plan design options with monthly rates.

Not sure why the Feds didn’t offer this from the start. It certainly is a more user-friendly option, and it could have curbed some of the roll-out problems as the website bogged down with people creating accounts with the intention initially of simply shopping versus enrolling.

The reason I suggest not pouring the champagne just yet on this latest update is because although the plan information and rates are available on the website, the data is not complete.

For example, when I entered the basic information about my family the website returned 34 plan options, including offerings from Blue Cross Blue Shield, Humana and Kaiser Permanente. The results showed if the plan was an HMO or POS option and what category the plan fell into — catastrophic, bronze, silver, gold or platinum.

The metallic categories represent the actuarial value (AV) of the plan offerings. The AV is the “average measure of generosity” — the percentage of medical costs the plan will cover after premium payments.

Catastrophic and bronze plans have a 60 percent AV, while silver, gold and platinum plans have AVs of 70, 80 and 90 percent, respectively. The greater the AV, the higher the monthly premium.

The lowest cost plan for us was a POS catastrophic plan from Humana with a $6,350 annual deductible for $472.68 per month. I was intrigued. Unfortunately, I’m still intrigued.

I say unfortunately because I could not obtain any additional information about the plan design. There were no links on the website that would take me to a summary of benefits and coverage that would offer more details about that plan or any of the other 33 plans in the line-up provided by healthcare.gov.

Does the plan include copays for office visits or prescriptions? If so, what are those copays? What is the maximum out-of-pocket cost for the family should we have a worst case year?

One thing I always encourage clients and prospective clients to do when looking at a plan is to check the provider listing for their doctors, hospitals and pharmacies. Years ago, carriers printed massive provider books with all providers listed that became outdated not long after the books hit the streets.

These days provider searches are conducted online and take just a few minutes. Since healthcare.gov is supposed to make things easier for us, surely there is a way to check provider participation from the website, right?

If I may borrow a line from the Elvis song, “Return to Sender,” “No such number, no such zone.”

So, the good news is we are one step closer with plan options and rates being listed for people to review, but until those interested can review the actual plan details and search for their provider it’s hard to make an informed decision.

I guess we will have to take the tip that someone told me they heard from the healthcare.gov 800-number helpline and “try again later, maybe late at night.”

Questions or comments? Feel free to email me at twilson@nfp.com.

Tony L. Wilson is a partner with NUVISION Financial Corporation based in Conyers. NUVISION is a subsidiary of National Financial Partners Corp. (NFP), which provides benefits solutions for companies.