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Marketplace confusion opens door to questions about skinny plans

Julie Appleby, Kaiser Health News on

Published in Health & Fitness

The new plans promise to be a solution for individuals who say that conventional health insurance is too expensive. Those looking for alternatives to the ACA often earn too much to qualify for tax subsidies under the federal law.

Donna Harper, an insurance agent who runs a two-person brokerage in Crystal Lake, Ill., found herself in that situation. She sells the Xpress plans -- and decided to buy one herself.

Harper says she canceled her BlueCross BlueShield plan, which did meet the ACA's requirements, after it rose to nearly $11,000 in premiums this year, with a $6,000 annual deductible.

"Self-employed people are being priced out of the market," she said, noting the new Xpress plan will save her more than $500 a month.

The Xpress Minimum Essential Coverage plans come in three levels, costing as little as $93 a month for individuals to as much as $516 for a family. They cover preventive care -- including certain cancer screenings and vaccinations -- while providing limited benefits for doctor visits, lab tests and lower-cost prescription drugs.

There is little or no coverage for hospital, emergency room care and expensive prescription drugs, such as chemotherapy.

 

Harper said she generally recommends that her clients who sign up for an Xpress plan also buy a hospital-only policy offered by other insurers. That extra policy would pay a set amount toward in-patient care -- often ranging from $1,500 to $5,000 or so a day.

Still, experts caution that hospital bills are generally much higher than those amounts. A three-day stay averages $30,000, according to the federal government's insurance website. And hospital plans can have tougher requirements. Unlike the Xpress programs, which don't reject applicants who have preexisting medical conditions, most hospital-only coverage often does. Harper says she personally was rejected for one.

"I haven't been in the hospital for 40 years, so I'm going to roll the dice," she said. And if she winds up in the hospital? "I'll just pay the bill."

About 100 brokers nationwide are selling the plans, and interest "is picking up quick," said Edward Pettola, co-owner and founder of Xpress, which for years has sold programs that offer discounts on dental, vision and prescription services.

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