Journalism in the Public Interest

What’s Wrong With’s Price Estimator

In the early days of, I praised the Centers for Medicare and Medicaid Services for publishing a dataset with sample rates for every health plan participating in the federal health insurance marketplace.

It seemed like a great, early example of transparency in this months-long enrollment period. The dataset is a decent size — 78,000 rows — and provides information by health plan, state and county of residence.

For every plan, it includes sample rates for a 27-year-old adult, a 50-year-old adult, a family (2 adults age 30, 2 children), a family with a single parent (1 adult age 30, 2 children), a couple (2 adults age 40, no children) and a child of any age.

It seemed like a good apples-to-apples way of comparing health plans in a market. But what is a good comparison tool for the media and researchers, we’ve come to learn, is not working for consumers.

One of the early criticisms of is that it forced users to register (a tedious and often unsuccessful process) before they could find plans and their prices. That decision was a major area of criticism during a hearing yesterday before the House Energy and Commerce Committee.

In recent days, officials at the U.S. Department of Health and Human Services have touted a solution that went live this week: a new tool on that allows users to “window shop” without logging on.

"This tool provides a user-friendly way to see high-level plan information with examples of pre-tax credit prices," HHS spokeswoman Emma Sandoe said in a statement when the tool was released. She added that most consumers will qualify for credits, resulting in lower premiums than those quoted.

But on Wednesday, CBS News reported that the tool could be wildly misleading because it quoted prices for only two groups (49 and younger, and 50 or older). The first group was based on a 27-year-old’s cost while the 50 and older was based on a 50-year-old’s. If you’re, say, 48 or 63, your prices could be much higher.

I decided to see for myself how this new price tool differs from the actual rates quoted when I log into the account I created on (I’m 39 years old and live in New Jersey.)

As CBS found, the price comparison tool notes that the prices listed may be lower because many people are eligible for subsidies.

What it doesn’t prominently say is that your cost may be higher if you’re older than the ages used for the comparison.

Here are a couple examples of what I was told from the price comparison tool and what I was actually quoted when I logged in to my account:

Price comparison tool

Actual site

That’s a difference of $562 a year. But I also learn when logging in that this plan comes with a $2,350 deductible before it covers my health expenses (except for preventive care, which is free).

Here’s another example with a different insurer.

Price comparison tool

Actual site

This is a difference of $700 a year. And this plan has a $2,500 deductible.

The co-payments differ in both plans, and I still would need to see if my doctors take whichever plan I would choose.

The bottom line is that HHS can and should do a better job of making accurate information available to those who window shop. That doesn’t require a major technological investment.

Mary Lea McTurnan

Oct. 25, 2013, 4:36 p.m.

This is a very helpful, and insightful explanation of the Gordian knot the public has been challenged to unravel . Personally, I’m goibg to wait a few weeks to see if improvements are made….and spare myself the the grappling ...I hope ... that friends and colleagues have been enduring

from here I want to know how people who aren’t covered by an employer plan get healthcare insurance—not healthCARE—from the insurance companies who have signed on to the federal and or state exchange.  I’m troubled about the lack of explanation between what one pays in premiums versus what one receives in actual healthcare.  how can we have a conversation about healthcare if low wage workers or even middle income workers can’t afford an insurance plan on the federal or state exchange?  we have lots of work to do…

If you do that with your state as Mississippi, you get 0 plans if your looking for a plan for an individual plan.

Barbara Waldman

Oct. 26, 2013, 12:15 p.m.

You have no idea how grateful I am that I’m on Medicare for many years and don’t have to deal with this terrible problem that so many uninsured people are now facing.

From the first time he ran for office medical insurance was supposed to be the cornerstone of Obama’s presidency.  Now that it is finally being implemented one has to wonder why, if it was so important to him, didn’t he stay on top of the situation.

clarence swinney

Oct. 28, 2013, 11:58 a.m.

calendar years-current dollars-average per year-
Clinton—$1360 Billion
Bush——-$2480 Billion
Obama—$3710 Billion (5 years)
Source: 2013 Global Almanac

Warren Spellman

Oct. 28, 2013, 1:51 p.m.

When looking at this and other stories, it seems to me impossible to believe that low wage income earners will actually sign up for these subsidized plans.  The deductible is the huge barrier, and unless the priced come down to below $50 per month, these young adults will not sign up for it.  Only the desperately ill, with serious care costs that exist already, will pay the $150 a month or so that most plans offer.
  This product is not going to sell in Peoria.l

The healthcare world is incredibly confusing. This administration has completely botched the roll out of this plan, but they did not create the confusing marketplace. I went through a personal research project for our family 18 months ago. It took me 4 months to research and compare plans. We are a very healthy family, but for a decent plan with a massive deductible we were still looking at $700-$900 per month. It’s simply a very expensive proposition. We entered into it as a a gamble against a catastrophic injury. That’s the bottom line. Everyone needs to be prepared to pay for a certain amount (the deductible or less) if they remain healthy, and insurance provides preventative and protects against massive expenses like broken bones or giving birth or longer term illnesses. I wish everyone who is complaining now had tried to find a reasonable plan before this rolled out. It was never cheap or easy.

Jeannie, you’re right, and it’s worth pointing out that it’s not an accident.  Insurance companies have developed a culture of obfuscation, so that they have the freedom to grab whatever money they can.

If it was simple, we’d know that they charge this group or that extra because they can get away with it.

That’s my objection with the ACA:  It further entrenches the power of the two most disruptive influences on healthcare, the AMA and the insurance companies, rather than trying to improve care or lower costs through competition.

As to the article itself, these things happen, but I’m curious as to why this is.  It could be because not all the data got populated, which may in turn be because some company supplied poorly-structured date.  Or, it could be because someone coded the thing wrong.  The former is most likely, but who knows?

This article is part of an ongoing investigation:
Obamacare and You

Obamacare and You

The Rollout of the Affordable Care Act has been marred by glitches and political opposition.

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