2:47pm

Mon August 18, 2014
Affordable Care Act

New York healthcare premiums vary widely depending on county

Average Metal Plan Premiums By New York County Groups
Average Metal Plan Premiums By New York County Groups
Credit http://www.healthpocket.com/

The average premiums for different levels of health insurance can vary widely depending on which New York County you live in, according to research prepared for the Innovation Trail and WXXI's Understanding The Affordable Care Act reporting project.

In some cases the differences in the cost of monthly premiums at the same coverage  level can vary by as much as $100, depending on the region.

For example, the average premium of Bronze Level coverage in the Monroe, Ontario and Wayne county group is $278, compared to $384 in the Albany, Greene and Rensselaer county group. 

Under the Affordable Care Act, different level plans are represented by 'metal levels' with Platinum representing the highest level of coverage and Bronze the lowest.

For the purposes of this comparison, New York counties were grouped around major upstate population areas to reflect density.

The research was carried out by non-partisan health technology company healthpocket.com

In other points of interest, the average monthly for the highest level of cover (Platinum) can be twice the cost of the average premium at the lowest tier (Bronze). (See County Group 5: Franklin and St. Lawrence)

The Erie, Niagara Counties' average Platinum premium was the lowest of the county groups ($516), while the Capital region's Platinum level average premium costs nearly $200 more ($695).

Some notes on the data from Kev Coleman, Head of Research and Data at HealthPocket, Inc.

"Each row in the attached spreadsheet lists average premium, deductible, and MOOP (i.e. Maximum Out-Of-Pocket expenditures for covered medical services within a calendar year) for every county zone and every metal level. New York is the only state to my knowledge that bans age rating for individual health insurance premiums and uses a “community rating” for premiums*. Consequently, we used a single age profile for this market since it would not affect the results. The census profile for the quotes that underly the averages was an individual with a birthday on 1984-01-01. The effective dates for the health insurance plans was 2014-09-01. If the deductible was listed as "No Maximum", then we used the MOOP value as the deductible. If the deductible was listed as "Not Applicable", then I used $0 for the deductible."

*Healthcare.gov describes "community rating" as: a rule that prevents health insurers from varying premiums within a geographic area based on age, gender, health status or other factors.

Other analysis by Kaiser Health News shows that care costs can vary widely within counties, something which the "community rating" of New York's system mitigates against.

The Congressional Budget Office which provides non-partisan analysis for the U.S. Congress says that factors affecting health insurance premiums include the costs of administering health plans and,

..an insurer’s costs for covered services in turn reflect the scope of benefits that are included, the plan’s cost-sharing requirements, and the health status of the plan’s enrollees.

The healthcare.gov website has more on the factors that influence premiums.

Research by the Leonard Davis School of Health Economics also points to "lack of economies of scale and lack of competition among providers", as influencing differences particularly in more rural areas.

For more on rural healthcare, listen to this discussion from the Healthy Friday edition of Connections with Evan Dawson.

Below are the zip codes used to quote for each county zone. The attached spreadsheet also contains the same information for cross-reference.

County Group #1: Monroe/Wayne/Ontario, Zip codes: 14621, 13146, 14471

County Group #2:Erie/Niagara, Zip codes: 14038, 14108

County Group #3: Broom/Tompkins/Chemung/Tioga, Zip codes: 13763, 14882, 14838, 14859

County Group #4: Onondaga/Oswego/Jefferson/Lewis, Zip codes: 13066, 13114, 13636, 13631

County Group #5: Canton/Franklin: Zip codes: 13617, 12939

County Group #6: Albany/Rensselaer/Greene, Zip codes: 12077, 12144, 12083

Fore more on the Affordable Care Act also visit wxxi.org

Comparison of average metal plan premiums by Upstate New York County Groupings