North Carolina Marketplace example

I helped a family of 5 look into North Carolina’s Obamacare marketplace to define their options. Here is what I found.

CURRENT COVERAGE

  • Family of 5 (ages 47 and 43), 3 kids (a teen and two adolescents). All non-smoking
  • Self employed, with Income of around $75,000
  • Currently covered by Blue Cross, Blue Shield N.C.
  • Monthly premium of $1,300/month, with a $5,000 deductible, with further cost share after that met

AVAILABLE IN NORTH CAROLINA MARKETPLACE (Silver Plan shown; note premiums lower and out of pocket higher for Bronze plan; vice versa for Gold or Platinum level)

  • Total premium, $1,125/month, with family portion around $550/month, federal tax credit around $575/month
  • Some services covered with no deductible, but can have substantial out of pocket costs depending on use. But, certainly not first $5,000 before coverage kicks in
  • Benefits are expansive (it is unclear to me exactly what the benefits are like in the current policy)
  • Coverage provided by BCBS NC (they are only insurer selling in all 100 NC counties)

Bottom line: for this family of 5, the Obamacare marketplace looks to be quite a good deal, given what they have been paying. They report underwriting in the form of a physical and then questionnaire. I don’t think of them as being sick (they work), but don’t know what factors may have influenced the current premium they pay other than it being individual v. pooled covered in the marketplace.

Even if this family had to pay the full premium (as they would if income were over around $110,000 [[400% poverty in N.C. at family size of 5]), they would save money and get more expansive coverage. With the federal tax credits, it is much better for them. If there are many stories of better cover for families making $75,000 leading to a premium reduction of $750/month, then…. wow. The most surprising thing to me on this N of 1 example is what they are now paying for coverage in the individual market.

update: fixed a mistake and revised slightly for clarity.

About Don Taylor
Associate Professor of Public Policy at Duke University and author of Balancing the Budget is a Progressive Priority. On twitter @donaldhtaylorjr

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