By Nicole Cardona
On October 1st, 2013, hundreds of thousands of uninsured New Yorkers will have a choice: purchase a health plan through the New York Health Benefits Exchange (NYHBE), or remain uninsured and face a $95 tax penalty. Those who decide to purchase insurance—presumably those previously uninsured due to prohibitive premium costs—are most likely to consider the two plans with the lowest premiums, Bronze and Silver. The premiums for Bronze and Silver plans must cover 60% and 70% of medical services, respectively. New Yorkers must weigh the pros and cons of each plan as they try to incorporate premiums into their monthly expenses.
As a second-year college student in Boston, I am safely under the coverage of my school’s insurance—a plan whose full cost, despite existing in confusing columns of fees owed and aid received, I did not even have to pay. Though I have two more years before I must worry about obtaining health insurance elsewhere, I can’t help but think about how the Affordable Care Act (ACA) will affect me once I leave school. Provided “future me” is in good health, I would have been very tempted to join the ranks of the uninsured or purchase catastrophic insurance to avoid monthly premiums. However:
1) By 2016, the tax penalty for being uninsured will be $695—or 2.5% of income. For me and for most New Yorkers, this number is an enormous deterrent.
2) Having a strong family history of breast cancer, I am supposed to begin receiving screenings at the age of 25 or 26 (the same age, ironically, that I would be removed from a parent’s insurance, were I using it). While the ACA preventative care provisions include mammograms without co-pays, they only apply to women over 40, so I would have to pay out-of-pocket for such screenings, regardless.
Considering these two factors, it’s likely in my best interest to purchase a health plan when the time comes—probably Bronze coverage, as it will be more of a struggle to pay high monthly premiums than minimize out-of-pocket costs, but this may be my youthful sense of invincibility speaking.
Yet, for somebody else—say, a non-smoking, 30-year-old single woman with no children, making $35,000 a year before taxes—choosing between Bronze and Silver coverage is a more difficult choice. The woman in this scenario could buy Bronze coverage and receive a $101 subsidy toward her $2,739 annual premium, paying $228 per month. Or, she could buy Silver coverage and receive the same $101 dollar subsidy towards a $3,426 premium, or $277 per month. With silver coverage, she’s responsible for 30% of her healthcare costs (as opposed to 40% with Bronze).
So what should she do? It depends on many factors—her monthly budget, her day-to-day health concerns, and how many specialists she may require, as the Bronze plan is expected to be the narrowest in terms of providers. Countless New Yorkers will have variants of this choice, and all the same factors should be considered. Because the costs for Bronze pricing were only recently publicized, not very much has been said about the level of coverage; therefore, people must know that flexibility is a priority the uninsured must take into account when choosing a plan.