Sunday, November 10, 2013

A private-market patch for the ACA?

About ten years ago, I used LendingTree.com to refinance my house. On the website, I punched in various vital statistics -- perhaps more than I'd be comfortable submitting today -- and, as advertised, received four bids from mortgagers.  Each sent offer details, I believe all by email.  Parsing the offers -- points, fees, etc. -- took some time, as with any comparison shopping for a financial product.  The small bank I went with gave me some heartburn by not approving the loan within the rate lock period, but they did extend that period, and I did get the loan at the advertised rate, within the estimated costs. It wasn't as easy as buying a camera on Amazon, but it was within reasonable expectation.

About seven years ago, I helped my older son, then 23, buy health insurance on New Jersey's bare-bones individual market exchange. There were basically three choices. AmeriHealth looked best, and they sent us a plan summary  -- I think three options at different price points.  We settled on not-terrible coverage -- at least, not terrible on paper, to my reasonably informed eye -- for about $180 a month.

Months ago, the Kaiser Family Foundation put up a provisional ACA cost calculator: punch in the number of people in your household, their ages, family income, and zip code, and get an estimate of the price of a silver or bronze plan, with and without the subsidy you qualify for, if any. It does not provide information for specific plans,however.

Now, it seems, there's a private-market, state-specific improvement, with pricing for actual plans and contact info for the insurers offering them:
I gave this a whirl, putting in my zip code, ages for my wife and me, and various income estimates. It works. There are no plan details (other than plan type -- HMO or EPO or POS), and I haven't called the insurers whose plans are quoted [update - see next post], but I would assume that they will send plan details if asked. [Update: per below, another site, ValuePenguin, appears to give more accurate price quotes, at least in New Jersey -- as well as plan details. Most insurers' websites do, too.]

Another missing link is detail in the income declaration. Subsidies for ACA exchange plans are calculated on the basis of Modified Adjusted Gross Income (MAGI) -- a variant on the more-familiar AGI we can all pull off our last tax return.  MAGI requires the applicant to add back into AGI income from a few fairly arcane sources that won't affect most applicants, but will affect some.

Moreover, it seems that the healthcare.gov hub by which insurers are supposed to be able to verify applicants' subsidy eligibility is not yet functioning well.  That's the real missing link here.

Nonetheless, if and when insurers are able to complete a transaction begun with customer contact prompted on HealthSherpa [or ValuePenguin], shopping for a plan on the exchanges would meet reasonable expectations for ease of use.

I should add that healthcare.gov, at which I have not been able to register despite about 40 attempts, also provides quotes to unregistered shoppers, based on one's zip code and the number of people in the household. It does not, however, provide contact information for the providers, and it does not prompt for household members' ages. I assume that the quote I got was for a middle-aged couple; it was about 2/3 the price of the quotes on HealthSherpa and Kaiser. I'm sorry to report, moreover, that in live chat I was given misinformation:
No age does not affect the premiums
That's true in some states, but not in New Jersey, which I specified as my base early in the chat [updated]. When I took three minutes to get the Kaiser calculator URL and verify that it adjusts price for age (I wanted to send back the URL), the help person (let's call her "Maida") signed off.

To paraphrase Jonathan Bernstein: Oy, Maida. Oy, healthcare.gov. Oy, Obama.

UPDATE, 11/11: The web-based service referenced below also works:

ValuePenguin does not highlight its calculator on its home page as HealthSherpa does, and it does not provide contact info for the insurers. But it does provide plan details, and HealthSherpa does not. Taken together, they offer pretty complete info. Both seem to be nonprofit, public service projects, though they're not 100% clear about that on their "about" pages.

UPDATE 2, 11/11: I checked both sites against those of insurers in New Jersey, and ValuePenguin appears to be accurate, while HealthSherpa appears to under-quote -- though the two are identical in two other counties in two states that I checked.   More info in the next post.

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