Helena Gudger is the type of person health insurance companies need on the books as the federal Affordable Care Act begins to roll out: Young, relatively healthy and hungry for coverage.
The 26-year-old Phoenix resident has gone the past four years without health insurance, using clinics and the county hospital for checkups, routine tests and visits to a gynecologist. She pays cash, checks prices and tries to go when doctors are offering discounts.
But she also is aware that she will be in a lurch if she gets sick. She does her best to avoid crowds where she could pick up an infection and even researches the local lake for outbreaks when her friends plan an outing. She wants to sign up for private health insurance as soon as the new federal marketplace opens in October.
“I know I have to plan ahead with certain events. I try to avoid crowded places where a lot of exchange of germs may transpire — I don’t want to get sick,” Gudger said. “It definitely makes you more aware of your surroundings. It’s a constant factor in the back of your mind.”
Insurance companies need young, healthy adults to buy insurance because new mandates under the federal health care reforms mean they can no longer turn away people with pre-existing medical conditions or charger older people much higher premiums.
They now must offer policies to everyone, no matter their health, and face limits on prices for older customers.
The twentysomethings and those in their early 30s who are most coveted by the insurance industry have a difficult decision to make as the health insurance exchanges begin accepting enrollment in October: Should they pay the $100 annual penalty for not having insurance or pay monthly premiums for coverage that might have high deductibles and out-of-pocket expenses?
Some six million people of various ages will pay the tax penalty for not having insurance next year, the Affordable Care Act’s first full year of implementation, according to the Congressional Budget Office.
Some younger people argue they don’t need insurance and will opt to pay the penalty, although by 2016 the fine jumps to $695 a year or 2.5 percent of taxable income, whichever is more.
Gudger said she is not in that category. A student at two-year Phoenix College who hopes to eventually earn a four-year environmental science degree, she just started a $13-an-hour, part-time job for a company selling solar panels. She has spoken with her mother about how the law will help her get insurance.
But she has little information about how the new federal marketplace — Arizona chose not to run a state program — will work, let alone the exact coverage the plans might provide. And while she may qualify for insurance through her employer in six months, that’s a long way off for her and she wants to know her options now, and for the future.
“What I know is pretty much I believe in the next year or so everybody’s going to have health care, whether you have kids or not,” she said. “Everybody needs to have health care in some form or another.”
Based on her income, Gudger will qualify for federal subsidies that will pay nearly half the premium for a midpoint “silver” plan, which covers 70 percent of costs and includes co-pays. An online calculator created by the Kaiser Family Foundation estimates her annual premium at $3,163 and the federal subsidy at $1,434, leaving her with a premium of $1,729, or $144 a month.
Even with the federal subsidies, that estimated cost is higher than what she hoped to see. And because she wants a decent insurance policy, not the bare-bones coverage cheaper plans offer, she’s still not sure just how she’ll proceed.
“If I was to be able to be offered affordable health insurance, I would say I would probably afford anywhere between $60 and $100 a month,” Gudger said. “I wouldn’t want to pay more than $75, considering I’d have to pay for prescriptions and copays if I have to see a doctor.”
BOB CHRISTIE, Associated Press