Much has been made about the promise of "if you like your current plan you can keep it." But what if I like my Obamacare plan that I get in 2014? Will I be able to keep that? The simple answer is – No.
The reason is that the new figures set forth in 2015 increase the maximum deductible from $2000 to $2150 and the out of pocket limit from $6350 to $6850. More on this in a minute.
Due to the strict metal tiers imposed under the law, several of the plans that have been approved in 2014 will not meet the criteria in 2015. It boils down to changes in benefit requirements coupled with a constantly changing average actuarial value calculation.
To better understand, consider this – when doing a mathematical calculation, you have two numbers that equal a third number. If you change one of the first two numbers, the third number will always be different. How does this relate to PPACA? If I have a strict actuarial value that must be achieved with the third number, then changing one of the first two numbers (like deductibles or out of pocket maximums) makes the problem mathematically impossible.
For example, in 2014 one of the plans offered by Medical Mutual of Ohio has an actuarial value of 80.5% which makes it a Gold plan. The benefits of this plan are:
- Deductible: $2000
- Coinsurance: 80%
- Out of Pocket Maximum: $4000
- Office Visit Copay: $25
- Specialist Visit Copay: $50
- Prescriptions: $15/$30/$50/80%
If I plug these same benefits into the 2015 proposed calculator the new actuarial value is 75.91% which makes it non-compliant. Oops! Under the law I won’t be able to keep this plan. This scenario isn't unique to MMO. Plans with Anthem, United Health Care, and others are in the same situation.
The President made it very clear that it wasn’t his fault that you couldn’t keep your plan. He now says it is up to your state insurance commissioner and insurance company if they want to allow you to keep your plan. Next year, when this exact same scenario happens with Obamacare-compliant plans, whose fault will it be?