The Affordable Care Act ushered in one of the largest health care transformations in U.S. history. Health insurance exchanges, a key component of the landmark federal health care law, were aimed at not only insuring millions more Americans but also stirring competition among insurers to drive down rising health care costs. But leading up to and even after the Oct. 1 debut of the federal-based and state-based exchanges, no one would say how much consumers could pay for a policy between both the cost of simply having coverage — their monthly premiums — and their total out-of-pocket costs. In Illinois, Gov. Pat Quinn focused on premiums, saying they were lower than many other states’ and more than 25 percent lower than predictions. We sought to tell the broader story. After obtaining each plan being sold on the Illinois Health Insurance Marketplace through the Freedom of Information Act, we focused on plans being sold in Cook County, the largest county in the state based on population and home to about two-thirds of Illinois residents. Our analysis shows that consumers should pay attention to more than their premiums. For 27-year-olds, a key typically healthy demographic targeted to help balance out of the expensive elderly population on the exchange, consumers’ average total out-of-pocket costs could be up to more than triple their monthly premiums when factoring in deductibles, coinsurance and co-pays, we found. In some cases, we found that out-of-pocket spending could be more than four times the annual premium. This analysis highlights the impact of a major shift in federal policy and details why consumers should make their decisions about health coverage based on more than just price. Buying the lowest-cost plan could lead to more financial pain in the event of a medical emergency because those plans typically provide the least generous coverage.
