Top Obamacare Insurance Companies
The Affordable Care Act (ACA), also known as Obamacare is in its fifth year of operating health exchanges nationwide designed to make healthcare coverage accessible to all Americans. Participation has declined for the third year in a row. Some of the largest health insurers in the nation (Aetna, Humana and UnitedHealth Group) have either exited the marketplace altogether or in almost all of their markets.
According the research by the Heritage Foundation, many insurers have exited the Obamacare exchange and the ones that remain may have higher premiums with less network coverage. In 2013 there were 395 insurers participating in exchanges. That number is down to 181 for 2018. Some of these exchanges exist as monopolies meaning that they only provide coverage from one carrier. Many of the participating Obamacare exchanges that are not large national carriers are sponsored by local hospital provider systems.
All marketplace exchanges plans are mandated by law to cover these essential services: emergency services, outpatient/ambulatory services, preventive/wellness services, maternity and newborn care, pediatric services, hospitalization, therapy services, prescription drugs, laboratory services, mental health and substance abuse services.
Those who have left the exchange have cited marketplace uncertainty as the reason for their exit. Continued subsidy payments are uncertain and these payments subsidize the co-pay and deductible amounts of at least 7 million customers. Every U.S. County has at least one insurer in their marketplace for 2018. Early predictions for 2018 show a stable Obamacare marketplace. Here are some of the top Obamacare Insurance Companies along with a breakdown of coverage facts:
Cigna participates in the Obamacare exchange in six states: Colorado, Illinois, Missouri, North Carolina, Tennessee and Virginia. Sign-up participants decreased to 11.8 million from 12.2 million the year before. Cigna offers four plans through the health insurance marketplace:
- Bronze: The bronze plan pays 60 percent and you pay 40 percent. This is the least expensive plan.
- Silver: The silver plan pays 70 percent and you pay 30 percent. This is a medium-priced plan.
- Gold: The gold plan pays 80 percent and you pay 20 percent. This is a high-priced plan.
- Platinum: The platinum plan pays 90 percent and you pay 10 percent. This is the highest priced plan.
All plans cover the full cost of annual check-ups, routine mammograms and diabetes screenings when you go to an in-network provider. All plans also cover vital care: overnight stays in the hospital, emergency room visits, clinic visits, pediatric services and other essential treatments to get better. Co-pays and deductibles will vary based on your plan, state of residence and the medical services provided. If you have to see a specialist, plans will pay some or all costs depending on your plan but you must have a referral from your primary care physician. You may be eligible to have a subsidy pay part of your marketplace plan premium depending on your household size and income. The summary of benefits and coverage for 2018 details specific benefits, co-pays and deductibles for each plan in each state in the Cigna healthcare exchange.
2. Centene (Ambetter)
Centene is a publicly traded insurer and recently expanded its participation in the Obamacare exchange 2018. Currently, Centene health insurance marketplace (HIM) states include: Arizona, Arkansas, Florida, Georgia, Illinois, Indiana, Kansas, Mississippi, Missouri, Nevada, New Hampshire, Ohio, Texas and Washington. Centene reports 1.6 million enrollees this year. Ambetter is Centene’s HIM product. Ambetter offers three HIM plans:
- Ambetter Essential Care (Bronze): This plan offers lower monthly premium and there are higher out-of-pocket costs.
- Ambetter Balanced Care (Silver): The balanced care plan is ideal for those who may be eligible for government assistance through subsidy payments. It balances premium payments of out-of-pocket expenses.
- Ambetter Secure Care (Gold): The gold plan has the highest monthly premium but has the lowest out-of-pocket expenses.
All essential health benefits are covered by each plan. Some plans also cover vision and dental care. Premium, deductible and co-payment specific along with the details of each plan available in each state can be found by selecting your state on the Ambetter website.
Anthem participates in Obamacare exchanges in 14 states through Blue Cross Blue Shield licensees. However, in 2018, it exited five states. These states do not participate: Indiana, Iowa, Maine, Mississippi, Nebraska, Nevada, Ohio, South Dakota, Utah and Wisconsin. There is only partial coverage in some counties: Arizona, Georgia, Kentucky, Minnesota, Missouri, Tennessee, Virginia and Washington.
Anthem healthcare exchange plan are offered in these four categories:
- Bronze: The plan pays 60 percent and you pay 40 percent.
- Silver: The plan pays 70 percent and you pay 30 percent.
- Gold: The plan pays 80 percent and you pay 20 percent.
- Platinum: The plan pays 90 percent and you pay 10 percent.
Plan options, deductible and co-pay amounts will vary by plan category and state. You can shop for individual and family plans on the Anthem BlueCross BlueShield website by selecting your state of residence.
4. Molina Healthcare
Molina Healthcare operates exchanges in nine states: California, Florida Michigan, New Mexico, Ohio, Texas, Utah, Washington and Wisconsin. Molina offers the following plans through the Obamacare exchange:
- Molina Bronze Plan: Combined individual deductible $6,400 for medical and prescriptions, with the deductible waived for specific services. Combined family deductible $12,800 for medical and prescription.
- Molina Silver 100 Plan: No deductibles for medical and prescription services.
- Molina Silver 150 Plan: $525 individual medical deductible and $1,050 family medical deductible. No individual or family prescription deductible.
- Molina Silver 200 Plan: $2,500 individual medical deductible and $5,000 family medical deductible. No individual or family prescription deductible.
- Molina Silver 250 Plan: $4,950 individual medical deductible, $9,900 family medical deductible, $400 individual prescription deductible, $800 family prescription deductible.
- Molina Gold Plan: $3800 individual medical deductible, $7,600 family medical deductible, no individual or family deductible for prescription.
All plans provide coverage for essential services. Depending on your income, you may be eligible for government assistance to help pay for coverage. Specific plan deductibles and co-pays vary by plan and state. For specific plan information, you can review all Molina health insurance exchange plans.