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California Woman Considers Insurance Options After ACA Rates Rise


This week the Obama administration revealed the rates for next year's insurance policies sold under the Affordable Care Act. The average premium will go up by about 22 percent across the country, but the cost to individual consumers will vary. NPR's Alison Kodjak spent some time with a California woman as she considered her health insurance options for next year.

ALISON KODJAK, BYLINE: Cindie Flannigan has spent most of the last few weeks worrying about her health insurance ever since she got a letter from Anthem Blue Cross and Blue Shield.

CINDIE FLANNIGAN: It says that my current monthly premium was $597.34, but it's going up to $802.09.

KODJAK: Now, Flannigan isn't paying that much for her insurance which she bought on California's exchange, which is known as Covered California. She's 57 and has her own food styling business in Los Angeles. With her income, she qualifies for subsidies that cut her share of her premiums for this year to $210 a month. So she went online this morning to see what the change meant for her.

FLANNIGAN: When I look up the exact insurance that I have right now, which is an Anthem Silver 87, it's gone up to $391.09. Yeah, for next year, my out-of-pocket will go from 210 to 391.

KODJAK: And that's just for the premiums. The Affordable Care Act is designed to protect lower- and middle-income people from huge increases in insurance costs. As premiums go up, subsidies are supposed to rise with them.

But those subsidies are based on a benchmark - the second cheapest plan in Obamacare's silver category, and that benchmark can change from year to year. So when the price of Flannigan's policy rose, the benchmark policy didn't rise as much. And that's what determines her tax credit subsidy.

FLANNIGAN: So the tax credit has gone up, but it hasn't gone up nearly as much.

KODJAK: Flannigan does have cheaper options. A Kaiser Permanente HMO would cost her only about $230 a month. It's a good price, she says, but also a big change.

FLANNIGAN: You know, I've never been with an HMO, and I hear that they do just fine. I just - I do worry about my primary care physician, you know, the doctors that I have been seeing for over 20 years. Then they're not on the list. I've already checked that.

KODJAK: There are three other plans that are even cheaper than Kaiser. One's just $77 a month. But their quality ratings aren't as high, so Flannigan's not really considering them. But she says she can't justify paying the extra $200 a month to keep her current insurance either.

FLANNIGAN: I was feeling horrible about having to switch doctors, but I've been talking myself into going with an HMO for the last two weeks. And I think I've just finally come around to thinking that's what I have to do.

KODJAK: Flannigan isn't unique. As people learn about the new prices for their own health plans, many will face difficult decisions about how much they can pay and whether it's worth shopping around for a better deal. Alison Kodjak, NPR News. Transcript provided by NPR, Copyright NPR.

Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.