Health exchange: Utah family gets coverage for $123 a month
Affordable Care Act • Access to the online marketplace appears to be improving.
This is an archived article that was published on sltrib.com in 2013, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

It took half-a-dozen tries over several days. But Phil Sherburne struck gold on Saturday — silver actually — with family health coverage purchased on the Affordable Care Act's online exchange.

After plugging in particulars about his family of five, the Salt Lake City business owner was able to compare 38 plans and apply for tax credits to put toward his monthly premiums. He settled on a silver-level plan from Altius that retails for about $850 a month.

After tax credits, the Sherburnes will pay just $123 a month.

"It's a great deal. I'm thrilled to have coverage, period," said Sherburne, who was previously shut out of affordable insurance due to a pre-existing condition, a shoulder injury. "Once I got onto the site it took about an hour, start to finish."

Overwhelmed by high demand and technical glitches, healthcare.gov had a rough Oct. 1 launch. Early shoppers struggled to use the site, often getting bounced off or blocked by a "please wait" page.

Federal officials have since added server capacity and brought the website down for fixes. A week later, reports of successful shopping experiences are trickling in.

"I was able to finally get on. I could see rates and plans that are very comparable to what I have now, and for less money," said 61-year-old Sandy Crockett of Cottonwood Heights.

Read the fine print, though, warns Crockett, who formerly worked in human resources and is accustomed to vetting health plans. Many of the exchange plans have narrow provider networks, so it's wise to examine the "provider directory" links attached to the various plans to make sure the hospitals and doctors you want are covered before buying, she said.

Judging the affordability of the 96 exchange plans available to Utahns is difficult, because prices vary depending on where a family lives, how many in the family enroll and their ages.

Prices also hinge on subsidies offered to households with incomes below 400 percent of the federal poverty level.

The median family income in Salt Lake City was $68,578 in 2012, and the average-sized family is a family of three. Such a family, under the Affordable Care Act, would qualify for an annual subsidy of $897.88, or $74.82 per month.

Put toward the purchase of the second cheapest silver plan on the exchange — Select Value Preference Benchmark Silver 1000, which retails for $7,412.88 per year — this family's monthly insurance rate would be $542.92.

That's about double what the average employer-insured family pays in Utah because employers typically help pay for premiums. But exchange plans include a list of must-have benefits, such as mental health care, that many employer-based plans don't cover.

And the value of employer-based coverage has declined over the years as more of the costs are pushed onto workers in the form of high deductibles, co-insurance and co-payments.

Sherburne, self-employed and uninsured for years, found a plan with no deductible and zero co-pays.

"It's a big deal for our family," said Sherburne, who has been paying cash for doctor visits and the occasional emergency room visit. They've so far avoided the kind of health calamity that forces families into bankruptcy.

Leia Bell, his wife, "this year had a bout with gall stones. The ER bill was about $3,000," he said.

Sherburne and Bell own and run Signed & Numbered, a frame store in South Salt Lake. Business is steady, but they run on lean margins and a year-and-a-half after the shop's opening, they had to make cuts and jettison their health benefits.

Sometime later, Sherburne tore his rotator cuff playing softball, pushing rates further beyond reach.

"From that point on, I was denied by most insurers," he said. "We tried to get insurance for the business, but because of my injury they rated us up by 40 percent."

Eager to survey the exchange, Sherburne tried shopping it on the morning of Oct. 1. He couldn't get past the home page.

He tried again several times on Thursday, morning and night, and would make some headway only to get bumped off. He called the 1-800 number and hung up after spending 11 minutes on hold. Live chat operators on the website encouraged him to keep trying, but couldn't answer his questions.

But Saturday brought success.

"Each person in the family requires about a page of information, stuff like birth dates and income," he said. "It immediately told us what our tax credits would be and asked if we wanted to apply the money directly to the premium or take it at the end of the year."

Sherburne surveyed 38 different plans, and picked five for closer comparison.

"A link pops up and you can click it to compare the premium, deductibles and co-pay and yearly maximum out of pocket costs," he said. "We found a high deductible plan that would have cost us $5 a month after tax credits."

Sherbrune finally settled on a silver-level plan with the right set of benefits. "We didn't need stuff like pain management," he said.

He was able to click on a page where he could search to see if his sons' pediatrician was included. "It was really slick," he said. "Once they get the bugs worked out, it will work well and bring peace of mind to a lot of people."

kstewart@sltrib.com

Twitter: @kirstendstewart —

Need help enrolling?

There are several options for those who need help shopping the Affordable Care Act's online health exchange:

Online chat at healthcare.gov

Toll-free call center at 1-800-318-2596

Go to www.takecareutah.org or call 211 to find the nearest trained navigator

Find a certified insurance broker near you at bit.ly/brokerfind —

Calculate your subsidy

The new online marketplace at healthcare.gov was designed to allow shoppers to find out whether they qualify for subsidies, receive them and apply them toward the cost of premiums.

Those having trouble using the site can get an estimate using an online calculator from the Henry J. Kaiser Family Foundation here: http://kff.org/interactive/subsidy-calculator/

Americans who qualify for subsidies earn between 100 percent and 400 percent of the federal poverty level. In that window, individuals earn between about $11,000 and $44,000, and a family of four has an income between $33,000 and $92,000.