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Special Report: Insurance plan costs under Obamacare

Published On: Dec 24 2013 03:05:53 PM CST
Updated On: Jan 16 2014 06:57:05 PM CST

Reporter: Maria Garcia

EL PASO, Texas -

Editor's Note: For a glossary of terms you will see throughout this story go to the bottom of this article.

The troubles with the healthcare.gov website are well-documented.

But ABC-7 figured out a way to bypass it and learn how much the insurance plans will cost by going we straight to the insurers.

"It's going to be a fine balance,” Dr. Andres Enriquez said, adding that there’s a lot of give and take under the Affordable Care Act. The ACA is commonly referred to as Obamacare.

ABC-7 looked up some real plans for a hypothetical cross-section of people with different ages, family sizes, and incomes.

Plans for Singles

For example, a 27-year-old man making $15,000 a year qualifies for big government subsidies. He'd pay just $25 a month for a policy with zero deductible.  His out-of-pocket costs would be capped at $500.

But it's a different deal for a 35-year-old woman who makes $30,000 a year. She doesn't qualify for any subsidies. The cheapest premium would be almost $140 a month with a deductible of at least $5,000 and an even higher cap on out of pocket costs.

“Six thousand dollars a year – that’s a lot,” Enriquez said. “A lot of my patients, they’re not going to meet that. Most of them aren’t but if you are 80 years old and you’re on seven or eight medications and have all kinds of diseases, you might meet the deductible.”

To avoid paying a deductible this hypothetical 35-year-old woman would have to pay about $300 a month and $6,000 out of pocket. The plan ABC-7 found that appeared most sensible had a $250-a-month premium, a $1,000 deductible and $3,000 out of pocket cap.

This hypothetical woman would be paying quite a bit too.

The younger and healthier you are, the better it is for Obamacare for you to sign up and start paying your premiums because the healthier you, the less likely you are to go see a doctor. And this helps alleviate and compensate for the older individuals.

Family Plans

This one is a young family of four - parents in their late 20s with two young children. They don't make a lot of money - only $25,000 a year, but they qualify for a full government subsidy. Just $42 a month buys them a plan with no deductible at all and out of pocket expenses capped at $500 per person..

But imagine another family of four - about 50-years old, making $95,000 a year - roughly what a couple of teachers would make.

They get no government subsidies. So their monthly premium would be a minimum of $560 a month with at least a $5,000 deductible and out of pocket expenses of more than $6,0000 possible.

A much higher monthly payment of about $1,200 could cut the deductible to zero.

The most balanced plan ABC-7 found for them still had a premium of $1,000 with a $1,000 deductible, and out of pocket costs capped at $3,000 per person.

In short, the plans and subsidies seem to benefit those who have low annual incomes or older people on a limited income, too.

“It'll probably benefit my older clientele, my older patients, the ones that are on 10 medications,” Enriquez said.

But for the young person, "that goes to the hospital maybe once every two years, it might now help him much to be paying $180-$200a month for a catastrophic type of insurance,” said Enriquez.

Glossary of Terms

Premium is how much you pay a month for your insurance plan.

Deductible is the amount you have to pay before your insurance starts kicking in.

Out of pocket costs are things you'll have to pay on your own - sometimes even after your deductible.

Subsidies are what the government pays for your plan.

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