Rare metal: Where are the Platinum plans?

Runako Godfrey didn’t mind the expense. He wanted a level of insurance coverage he could count on.

Godfrey and his family, who live in Atlanta, were covered in 2015 by a Platinum-level health plan, the category with the highest monthly premiums.

Besides that, he paid full price.

Most people who purchase health insurance through Georgia’s ACA-created exchange get a subsidy or tax credit to defray the cost. But Godfrey, as a small business owner, had too high an income to qualify for that discount. So he looked outside the exchange and bought his policy there.

Godfrey, 41, said Platinum suited his plans. “We were considering having a baby’’ at the time, he said, and the year before they’d had some unexpected medical costs.

So he paid more than $1,200 per month last year for the Platinum offering from Humana, covering his family of four.

But this past fall, Godfrey received a letter from Humana informing him that it was dropping his Platinum plan in 2016. “I kind of freaked out,’’ he said.

HealthCare.gov Stock imagery

Godfrey then checked Georgia’s exchange for a Platinum plan to replace the Humana one, but there were none offered.

Most states have opted to let the federal government operate their exchanges, and several states with federally run exchanges are not offering any Platinum plans for 2016. Georgia is one of those states.

The answer may partly lie in cost – and consumer demand. Platinum plans have a high upfront cost in monthly premiums, and perhaps because of that, not many people buy them.

Platinum generally has the highest premium of the four categories of plans, while featuring lower out-of-pocket costs for members.

The plans will typically pay 90 percent of covered health care expenses (if the care in administered within a consumer’s network), and the consumer pays the remaining 10 percent in the form of out-of-pocket expenses such as deductibles and co-pays.

A publication of the federal Department of Health and Human Services shows the difference in premiums in the United States. The average lowest-cost 2016 premium for an individual policy (before the subsidy or tax credit) for a Bronze plan is $294; $359 for Silver; and $406 for Gold. For Platinum, it’s $550.

The lower “metal” plans tend to have higher deductibles and other consumer costs.

But state officials also say the Platinum plans tend to attract people with chronic illnesses, and thus may drive up insurers’ costs.

Companies take note

Just 3 percent of Americans in the federal exchange states chose a Platinum plan on those exchanges for 2015, down from 4 percent the year before, HHS reported in March.

Nationally, an average consumer can select from an average of two Platinum plans in a county in 2016, down from four in previous years, the agency reported in October.

Georgia offered a total of seven Platinum plans in the exchange’s first year, 2014. Last year that number dropped to four.

Runako Godfrey and family
Runako Godfrey and family

Graham Thompson of the Georgia Association of Health Plans, an industry trade group, told GHN recently that there was not enough consumer demand for Platinum exchange plans in Georgia to sustain them.

America’s Health Insurance Plans, a national trade group, said insurers have made major adjustments after three years of experience with the exchanges. The changes were shaped by “consumers’ preferences for coverage and the significant losses sustained by many plans in the exchanges,’’ said Clare Krusing, an AHIP spokeswoman.

She also cited a shortfall in “safety-valve’’ payments by the federal government, which essentially limit how much money an insurer can lose or gain on its exchange plans.

Bill Custer, a health insurance expert at Georgia State University, said individuals who desire a Platinum plan are most likely not eligible for a subsidy in their exchange and may therefore be shopping for better deals outside the exchange.

The Georgia insurance department said in a recent email to GHN that Platinum plans appear to attract consumers with chronic illnesses.

“It will be a ‘deal’ to them,’’ said the email from Steve Manders, director of insurance product review for the state insurance department. “Consumers selecting this rich coverage know or strongly believe what they are likely to experience in patterns of needed care and treatment for their ailments.  They have a good idea of their expected health claims and claim expenses.  And they believe it is likely that their claims could easily outstrip the level of premiums they would pay for this richer, more expensive category of Platinum coverage.”

The agency said that the Platinum plans that the department approved for the 2016 Georgia exchange “were subsequently withdrawn’’ by the companies.

There were still Platinum policies being offered outside the exchange by Georgia insurers, according to Manders.

But Godfrey, who said he was unaware of any such offerings, wound up choosing a Silver plan from Humana, once again outside the exchange. He’ll pay a much lower amount in premiums.

Cindy Zeldin
Cindy Zeldin

Still, “the frustrating part of this is how difficult it is to compare these plans,’’ he said. “I don’t like a lot of unknowns in health care.”

Humana said Monday that it had dropped the Platinum plans in Georgia “in order to retain the overall affordability and access of the individual health plans offered by Humana.”

Most consumers pick Silver plans and have expressed satisfaction with them, noted Cindy Zeldin of the consumer group Georgians for a Healthy Future.

“Still, the metal tiering was established so that consumers could choose a more generous plan if it met their needs and they were willing to pay the higher premium. Some consumers may want the predictability for their family budget that comes with a lower deductible, particularly if they have health needs,’’ Zeldin said. “And while it is important for the vitality of the marketplace that people representing a range of ages and health statuses enroll, it is also important that people with chronic health conditions have the access to care they need.”