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Reality Check: Health care exchange costs depend on where you live

By Jessica Arp, jarp@wisctv.com
Published On: Sep 26 2013 06:53:03 PM CDT
Updated On: Sep 26 2013 08:59:08 PM CDT
MADISON, Wis. -

The cost to purchase health insurance sold under the new federal care overhaul will be higher in Wisconsin than the national average, but how much you pay will depend on where you live.

Information from the U.S. Department of Human Services compared weighted average premiums among 47 states and the District of Columbia, and information released Wednesday showed Wisconsin ranking 36th nationwide in average monthly premium costs. Put another way, Wisconsin residents will be paying the 10th highest rates in the country.

In Wisconsin, the mid-level plan on average will cost $361 a month in premiums. That compares with a national average of $328. Those costs are before people apply any tax credits they may be eligible to receive.

But what your price tag could be will likely depend on where you live, among other factors.

Of the 13 carriers who said they'd offer exchange plans in Wisconsin, they may not all be offering plans where you live. Most counties in the WISC-TV viewing area have at least three options for providers, including GHC, Dean and Unity. Some have more, adding in providers like Mercy or Gundersen, and some have fewer choices. Marquette and Green Lake counties only have one option for a provider.

Will all plans cost the same? No. The state was broken up into 16 service areas. Dane County is a service area on its own, and the WISC-TV viewing area includes about five other areas.

The insurance companies serving these counties set their rates by area. So for example, a Dean, GHC or Unity plan may cost a different amount in Dane versus Sauk county.

"It really depends on the carrier in terms of how they priced before and where they put themselves in the market to how they have to price tomorrow under the new federal law in the exchange," said Dan Schwartzer, Wisconsin's deputy commissioner of insurance.

What we can compare right now are the lowest cost plans. In Dane County, the plans range from $104 for a catastrophic plan to $241 for a gold plan. But where you see a difference is in the comparison. In Iowa/Lafayette/Grant counties, the lowest cost gold plan is $272 a month, which is early $40 a month more than the Dane County option. In fact, the Iowa, Lafayette and Grant county area has the highest of the lowest costs for every plan level in our viewing area. And if you're thinking you'll just county hop for coverage, think again.

"The federal law is based off the county in which you live, so if you lived in Sauk County you're only eligible to purchase plans from qualified health providers offering coverage in Sauk County," said Schwartzer.

Of course these are just the low-end prices, and they don't factor in your age, health or any tax subsidies you may be eligible for. We'll know a lot more about these costs once the marketplace opens Tuesday.

Columbia, Green, Jefferson and Rock counties will have the largest number of health plan options to choose from. Across the four categories there will be 166 plans available in that region.

If you have an idea for a Reality Check, or a question about the Affordable Care Act, send it to us at realitycheck@channel3000.com.

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