The insurance department tables also contained other important warnings for consumers that reporters covering this stuff would do well to discuss in their stories. It said the listed rates did not include subsidies, which Gouras did note. That’s important, and it means means qualified people will end up effectively paying even less. But the rates also did not include premiums for dental coverage, which we’ve pointed out is an underreported story line, or surcharges for smoking. Both can result in higher premiums for some families.
But a black box warning on rates for the Montana exchange contained the real caveat:
The cost sharing in this summary applies to ‘in network” services only. Out- of network services have higher cost sharing. Please see the policy language. Be sure to review plan details to know what applies to deductibles, exact copays and insurance for particular services, out-of-network coverage, excluded benefits, formularies, provider networks, etc.
In other words, the coinsurance amounts simply listed on the department’s website don’t tell the whole story. Is it the same for out-of-network services? Are the deductibles higher? And if the provider networks are narrow, as they will be for many low-cost policies, some people will likely visit a doctor or hospital outside the network—which could be very costly. So you see there’s more to the low premium story coming from the exchanges than most journalists have reported on.
At best such stories are incomplete. At worse, they are misleading. It would be great to see the AP do a full explainer.
Follow @USProjectCJR for more posts from @Trudy_Lieberman and the rest of the United States Project team, including our work on healthcare issues and public health at The Second Opinion. And for Trudy’s resource guide to covering the ins and outs of buying insurance on the state exchanges, see Open Wide, from CJR’s July/August issue.