MONTPELIER, Vt. (AP) — Vermont regulators on Monday announced monthly rates for the state’s Patient Protection and Affordable Care Act (PPACA) exchange plans.
The state’s Green Mountain Care Board (GMCB) has given final approval for the rates for the individual and small-group “qualified health plans” (QHPs) to be sold through the Vermont Health Connect system.
Vermont is trying to have all individual and small-group health insurance sales go through the exchange.
The exchange is supposed to start enrolling consumers in QHPs Oct. 1, with the first coverage sold starting to take effect Jan. 1, 2014.
Anya Rader Wallack, the GMCB chair, said the full market rates for QHP coverage will be similar to the rates customers pay in the commercial market today.
Federal tax credits and state premium subsidies should make coverage more affordable for moderate-income and lower-income state residents than it is today, Wallack said.
“For those who qualify for the tax credits and premium subsidies, there’s a pretty big difference,” Wallack said. “In terms of just comparisons with prices in the marketplace (today), the difference is less dramatic.”
Kevin Goddard, spokesman for Blue Cross Blue Shield of Vermont agreed, calling the rates to be charged when people buy his company’s insurance through Vermont Health Connect “comparable” to what they would pay without the exchange in place.
PPACA requires QHPs to fall into one of four “metal” levels, ranging from bronze plans, which will cover about 60 percent of the actuarial value of a standard “essential health benefits” (EHB) package, up to platinum plans, which will cover about 90 percent of the actuarial value of the EHB package.
Rates being offered for the benchmark “silver plan” for individuals will be a bit less than $395 per month for individuals buying a Vermont Blue product, and $410 a month for those buying a similar policy form MVP Health Care. Those prices are similar to what an individual pays now for a similar suite of coverage options, Goddard said.
Lower-income Vermonters will get federal tax credits and state premium subsidies to cover some of the costs. For someone making the median individual income of about $34,000 a year, that will reduce the cost of the Blue Cross plan to about $230 a month, and the MVP plan to $252.
The Blue Cross family plan will cost $1,111 a month through Vermont Health Connect. For MVP it will be $1,151.
The rates described by the Green Mountain Care Board are for a mid-range health insurance offering what it terms a “silver level” plan.
The standard EHB benefit package will include coverage for outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorder services, behavioral health treatment, prescription drugs, rehabilitative services, laboratory services, preventative care and pediatric services, including oral and vision care for children.
The Green Mountain Care Board said it shaved 4.3 percent off the rates initially proposed by Blue Cross and 5.3 percent off the rates offered by MVP. But Wallack said more needs to be done to control the cost of insurance and of the health care it buys.
The reductions will save Vermonters money, but “the underlying cost of health care and health insurance remain alarmingly high, and we have to redouble our efforts to address this problem,” she said.
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