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Experts Warn Of Rising Health Costs In Missouri Despite Lower ACA Premiums

Missourians buying health insurance on the federal exchange likely won't see the sky-high rate increases that have becoming common in recent years in 2019. But experts say the marketplace's woes are far from over.
David Kovaluk | St. Louis Public Radio
Premiums are only one cost consumers should look out for when buying an insurance plan, experts say.

Missourians shopping for health insurance on the federal government’sonline marketplace are likely to see slightly lower premium prices, but health economists warn residents could still pay more for their health care next year.

Deductibles, the prices customers pay out-of-pocket before insurance startas to cover bills, are increasing by $100-$200 a year on average, according to an analysis by the Missouri Foundation for Health. Some consumers have deductibles of more than $6,000.

The government restricts how much deductibles can rise each year, but many insurers are taking the maximum increase allotted, said Nancy Kelley, policy director at the foundation, which assists customers with signing up for health insurance.

“People really have to look at those details to make sure they’re not getting in a plan that, if they can help it, has a super high deductible,” she said. “Because then you have a lot of out-of-pocket [costs] before you have your coverage kick in.”

Kelley recommends that people buying on the Affordable Care Act marketplace answer the optional questions about their health needs during the sign-up process. Those answers help the website more accurately calculate patients’ total estimated costs.

The rural-urban divide

There are more insurers offering plans in Missouri than ever before, but prices can still vary widely depending on where customers live.

In St. Louis, where there are three insurers offering plans, a 27-year-old nonsmoker would pay $334 for the second-lowest-cost mid-tier plan before subsidies, according to analysis by Washington University’s Center for Health Economics and Policy. Four out of 5 people buying plans on the exchange qualify for government subsidies to offset the cost, Kelley said.

There are still dozens of rural counties in the state with only one insurer. Customers there will often pay hundreds of dollars more in premiums than their urban counterparts, said Abigail Barker, a researcher at the Brown School at Wash U.

For example, Anthem is the only insurer offering plans for 2020 to customers in Lewis County in northwestern Missouri. A 27-year-old nonsmoker there would pay $633 before subsidies — $300 more than the same customer in St. Louis. 

Rural counties will probably always have higher health care costs, Barker said, because there just aren’t as many people who live there.

“The insurance market is one that’s inherently about spreading risk,” she said. “If you don’t have as many people, it’s harder to do a good job calculating how risk will be spread.”

But a lack of competition also drives prices up, she said. “Work we’ve done over the years suggests very strongly you need at three issuers to have the prices being held down by competition.” 

St. Louis, St. Louis County and St. Charles County all have three insurers offering plans for next year.

Open enrollment on healthcare.gov runs through Dec. 15.

Follow Sarah on Twitter:@Petit_Smudge

Send questions and comments about this story to feedback@stlpublicradio.org

Sarah is the health reporter at St. Louis Public Radio.

Send questions and comments about this story to feedback@stlpublicradio.org.