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Unpacking BCBSRI’s rate request

January 12, 2012

Blue Cross Blue Shield of RI (BCBSRI) wants to increase its premiums by about 4.4% for folks that buy their own health insurance. If you’re one of those 15,200 so called “direct pay customers” you can testify about the request at a public hearing next Tuesday, January 17th.

But before you do, let’s talk about Blue Cross Blue Shield’s proposal. The request includes not just a rate increase, but changes to cost sharing and deductibles as well. I wrote about some of those adjustments in an earlier post, but I wanted to take another crack at explaining what’s different.

Let’s start with the changes to BCBSRI’s health plans. Here they are, side by side based on BCBSRI’s letter to Health Insurance Commissioner Christopher Koller and BCBSRI’s explanation of its current benefits.

The changes to the Healthmate direct 500/1000 plan are pretty simple- the deductible increases by $500 for individuals and $1,000 for families. That means if you have a health emergency and this is your health plan, you’ll have to pay $500 or $1000 more before your health insurance kicks in.

That’s also true for the “out of pocket maximum.” It used to be that the most you’d have to pay for your health care in any given year was $2,500 as an individual or $5,000 as a family. That number is now $3,000/$6,000.

You see the same increase in deductibles for the Healthmate direct 1000/2000. Deductibles here go up by $500 for individuals and $1,000 for families. Out of pocket maximums jump by even more- an increase of $1,500 for individuals and $3,000 dollars for families. Also notice that plan used to pay for diagnostic tests, x-rays, and lab fees. Now you’re responsible for paying for those services until you reach your deductible. After that, you pay 20% of the cost.

Healthmate direct 2000/4000 follows the same trend. Deductibles increase by $500 for individuals and $1,000 for families. But check out the out of pocket maximums. They skyrocket to a $4,500 increase for individuals and a $9,000 jump for families.

Healthmate direct 3000/6000 doesn’t have a change in deductibles, but it does switch from covering the entire cost of medical procedures/appointments/diagnostic tests to charging you 20% of those costs until you reach your out of pocket maximum.  That’s changed as well- $2,000 more for individuals and $4,000 more for families.

Of all of BCBSRI’s plans, Healthmate direct changes the least. The only difference is a tiny change in out of pocket maximums- $100 increase for individuals and $200 increase for families.

What do all of these changes mean for direct pay customers?  The rate increase for your premium might be 4.4%, but add up all of these changes and you could pay much more if you get sick or injured.

There are so many plan iterations and different charges based on age and health that I can’t calculate the price difference for everyone. But I can talk about myself. In my next post, I’ll calculate what I would pay under the changes. Here’s a hint-it’s more than 4.4%.

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