Insurance exchange will force choices

Shopping for insurance just got personal. Are you ready?

For decades, Brad and Heidi Stokes have put health care at the center of every important life ­decision.

Heidi Stokes, whose lupus was diagnosed when she was a teenager, picked her early career path around jobs that offered medical benefits. Husband Brad developed a rare liver disease in the late 1980s and has since had two liver transplants. Their college-age son, Christian, was diagnosed with diabetes when he was 15 months old.

As small business owners with complex medical needs, the couple have had only one realistic option for insurance coverage: the state’s high-risk pool. But that will change Tuesday with the debut of the MNsure insurance exchange, an online marketplace that gives individuals and small businesses a range of choices while using the power of competition and federal tax breaks to hold down costs.

“The idea that we could go shopping for insurance — and select something for ourselves — is just unbelievable,” Heidi Stokes said. “For the first time, I’ve got some hope for the future.”

MNsure and other state exchanges across the country are a critical element of the federal health care law known as Obamacare. Even as controversy continues to rage around the law, its final rollout in the coming months will bring a sharp change in how millions of Americans pay for health care.

While most people will still get insurance through an employer, those who shop on MNsure will decide for themselves which insurance company to use, how much coverage to get and what they’re willing to spend.

“What we’re seeing Oct. 1 is a reset button,” said Geoff Bartsh, a vice president with Medica. “Everyone is setting the table in a way where it’s easy to see what’s out there, what’s available and what the trade-offs are.”

Consumers visiting the MNsure website will be able to weigh various elements that matter to them, such as premium prices and whether their doctors or medications are part of a certain plan. They can shop online on their own, work with insurance agents, enroll directly with insurance companies or call a toll-free number for help.

Choosing a plan will require setting priorities. Lower premiums might mean higher copays, or a smaller network of physicians that might not include favorite doctors or hospitals. PreferredOne, for example, offers an open network of almost all Minnesota doctors and hospitals or a lower-cost network that consists mostly of the Fairview, HealthEast and North Memorial systems. Choosing the latter would mean paying more to see doctors at out-of-network places such as the Mayo Clinic.

Advocates say it’s different from the HMO movement of the 1990s, which consumers viewed as an invasion of their personal choice of doctors. After two decades of skyrocketing health prices, consumers are ready to make tough decisions between lower insurance costs and larger doctors’ networks, said Steve Peterson, PreferredOne’s marketing director.

“Think ahead of time,” he advised. “Would I be willing, if I could save a certain amount of money, to change” doctors?

MNsure leaders are confident that people who buy music on iTunes and bluejeans at Gap.com will figure out how to shop online for health insurance once they try the exchange.

Advocates and MNsure officials have tried to ready Minnesotans for the choices ahead, using town hall meetings and an amusing commercial campaign about the value of health insurance featuring Paul Bunyan and Babe the Blue Ox. But many people still aren’t familiar with the term MNsure or don’t understand the concept.

Seniors already covered by the Medicare may not know that it isn’t for them. Some people believe they will be forced to use the exchange, while others think it is going away because of the political standoff over Obamacare. Some believe MNsure itself is an insurance plan, rather than an online marketplace.

“MNsure?” asked a Coon Rapids woman who recently lost her workplace health benefits and will likely need to use the exchange. “Is that that Obamacare insurance?”

Still, MNsure is expected to be a key avenue to insurance coverage for many of the 500,000 uninsured Minnesotans, which proponents said is unparalleled.

“The system is bigger than anything I expected would ever happen in my life or at least in my career in health care, which is about 40 years or so,” said Deb Holmgren, president of Portico Healthnet, a St. Paul charity that for years has connected poor Minnesotans with health care and insurance. “It will have a major impact on that group of people who for years have been left out” of the traditional health care system.

The success of MNsure, and exchanges across the country, will depend on how easy they are to use and whether they give consumers answers in an easy-to-digest format, experts say.

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  • Brad Aaron, son Christian, and wife Heidi Stokes have been uninsurable for years and pay a huge portion of their salaries to be part of the state’s high-risk pool.

  • Heidi and Brad Stokes are hopeful about having insurance choices. “It has kept us alive. Without it, you are just one bad illness from being out on the curb.”

  • MNsure Plan Comparison

    Here’s a comparison of insurance plan costs on the MNsure exchange, using a hypothetical 30-year-old metro-area man who doesn’t smoke and wants a midlevel Silver plan. In general, higher premiums mean lower deductibles. Copays, coverage levels and doctor networks also vary and are key considerations.

    Blue Cross and Blue Shield of Minnesota

    Two Silver Plans

    Premium Range: $172.21-$187.93

    Deductible Range: $1,900-$3,000

    HealthPartners

    Two Silver Plans

    Premium Range: $147.28-$150.96

    Deductible Range: $2,500-$2,750

    Medica

    Four Silver Plans

    Premium Range: $187.03-$220.52

    Deductible Range: $1,300-$2,200

    PreferredOne

    Six Silver Plans

    Premium Range: $136.69-$159.45

    Deductible Range: $3,500-$4,400

    UCare

    Two Silver Plans

    Premium Range: $180.45–187.99

    Deductible Range: $1,900-$3,800

    There is also financial help available below certain income thresholds.

    • $15,282 or less qualifies for Medical Assistance

    • $22,980 or less qualifies for MinnesotaCare

    • $45,960 or less qualifies for sliding-scale subsidies on premiums

    Source: Minnesota Department of Commerce

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