OTTUMWA — Some professionals are wondering why Obamacare demands a single 21-year-old male buy a pricier plan that will cover him in case he gets pregnant.
"New plans must [have] all of those 'essential' requirements," said Heather Gerths, the employee benefit agent at McCune & Reed Insurance.
Those requirements tend to be things people may have had trouble getting covered in the past. For example, some Iowa plans limited the mental health benefits. Some of those requirements are gender specific, some are better for older Americans ... yet all must be contained in approved plans.
"The more benefits you have, the more expensive the plan is," Gerths said.
As an agent, she would find the best plan for her clients purchasing individual insurance. There were things some clients just didn't need, allowing her to find them a better value.
Now, it appears, not only must the single 20-something male pay a higher rate so he can have maternity coverage, his plan must also include pediatric care.
In fact, younger people looking for individual private health plans (as opposed to group plans) will pay more. And older people, in general, will pay less. That's because everyone who applies must be accepted without regard to their health. Healthy people pay the same as chronically ill people. So the sick people pay less than they would otherwise. The healthy pay more, she said. There are no more medical questionnaires.
Gerths has been plugging in some real and hypothetical numbers to get estimates to share with clients. And it looks like in general, prices next year will rise. In fact, they'd rise in the next few weeks in other states.
Luckily, said Iowa Insurance Commissioner Nick Gerhart, this year won't be as bad as predicted. His staff asked the insurance industry, like Blue Cross Blue Shield of Iowa, what they needed in order to give their best effort toward making this program work. Their request: more time.
Gerhart was appointed by Gov. Terry Branstad to run the Iowa Insurance Division, which is in charge of licensing for insurance brokers in the state. At his most recent visit to Ottumwa, he told the Courier that about 2,500 policies might have to be cancelled in Iowa. That's not nearly as bad as had been predicted, he said. The real pain comes next year.
"We gave Iowa carriers options," said Becky Blum, the ACA (Affordable Care Act, which is commonly called Obamacare) director at the IID. "They can cancel the plan, which has always been their option, they could amend the policy to meet the requirements, some wanted to have more time, or they could leave [this particular] market."
Most chose to take what amounts to an "extension" for their policy holders. In Ottumwa, Gerths has seen few cancellations, if any; the governor and his advisers bought companies and clients some time. But even in Iowa, it's not indefinite, she said.
"Blue Cross Blue Shield of Iowa has allowed [these policy holders] to hold on to their current plans until November of 2014," she said. "Those people can keep that 'older' plan but they can look at the new plans. That allows [Iowans] to take a wait-and-see approach."
She's not waiting, however; if the federal government listens to input from the industry and the policy holders, then improves the program, that'll be great, Gerth agreed. In the meantime, she and other agents will continue working through or around obstacles and educating themselves about Obamacare. For those who want to sign up for the ACA, she said, the healthcare.gov site does seem to be improving. If you need help, Gerths said, grab the phone book and call around. There are "navigators" who are certified to help (like the one at River Hills Community Health Center) as are a few area insurance agents who have been trained in the procedures of guiding residents through the process.
— To follow reporter Mark Newman on Twitter, see @CourierMark