Underinsured

Employee with bare-bones plan wonders if she can do better under ACA

2013-09-29T00:00:00Z 2014-07-01T15:38:46Z Employee with bare-bones plan wonders if she can do better under ACABy Emily Bregel Arizona Daily Star Arizona Daily Star

Between her monthly insurance premiums, prescriptions and insulin pump supplies, Tucson resident Karen Hollish shells out nearly $4,000 a year on health care.

“Health-care costs are a huge factor for me. I’m always trying to figure out a way to get them down,” said Hollish, who has Type 1 diabetes.

The 34-year-old marketing manager is insured through her employer, a pet-related nonprofit with just five employees. Her premiums are low — about $50 a month for her high-deductible plan — but she has to pay $1,000 out of pocket each year before her insurance kicks in. Even then, her plan only covers 50 percent of her costs.

Diabetics are vulnerable to eye ailments, but her company’s plan doesn’t provide vision or dental coverage. Hollish is unsure whether she should find a more comprehensive plan when the Affordable Care Act’s marketplace opens Oct. 1, or whether she should stick with her medical plan and pay for vision and dental care out of pocket.

“Can people like me buy cafeteria-style vision and dental plans, or would we be better off going to Mexico to get that stuff done?” she said.

Under health-care reform, vision and dental care must be offered for children’s health plans, but are not required offerings for adults.

Neither stand-alone vision or dental plans for adults will be available in Arizona’s insurance marketplace, said David Sayen, regional administrator for Region 9 of the U.S. Centers for Medicare and Medicaid Services.

State-run marketplaces can offer stand-alone vision or dental plans, but Arizona opted to have the federal government manage its marketplace, so that’s not an option, said Erin Klug, spokeswoman for the state Department of Insurance.

Hollish could seek out a comprehensive individual plan through the new marketplace that includes dental and vision, all included in one premium payment, but she worries she earns too much to qualify for federal subsidies to reduce her premiums.

Still, a comprehensive “platinum”-level plan would offer more coverage than her current plan, and she could end up saving significantly on her out-of-pocket contributions, said Daniel Derksen, professor and chair of the public health policy and management section of the University of Arizona’s College of Public Health.

“While you pay more on the front end, your co-pay and deductibles are lower,” he said. “She’ll still have to look closely at what’s offered and what’s included in the benefits package.”

As a small business, Hollish’s employer could also choose to offer employees a qualified health plan through the small-business marketplace that will open Oct. 1.

When the small-business and individual marketplaces open, consumers can explore specific plans and prices. In the meantime, online calculators like Kaiser Family Foundation’s subsidy calculator will help predict consumers’ costs, Derksen said.

Contact reporter Emily Bregel at 807-7774 or ebregel@azstarnet.com. On Twitter: @EmilyBregel

Copyright 2014 Arizona Daily Star. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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