Those who choose to shop for a plan on the Maryland Health Connection have the option to choose between four "metal" levels of coverage — bronze, silver, gold and platinum, which on average cover 60, 70, 80 and 90 percent of health care costs, respectively, according to the website.

In general, a platinum plan will have a lower deductible and out-of-pocket costs but higher premiums, making it well-suited to those who know they will use a lot of health care. A bronze plan, meanwhile, will feature lower premiums but a higher deductible and is better suited for those who expect they will go to the doctor less often.

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There is also a fifth type of plan, catastrophic coverage, that is only available for those younger than 30. These plans features low premiums and high deductibles and are designed for younger, healthy people who want the most minimal coverage as a hedge against major incidents.

Unlike in 2013, the Maryland Health Connection website now supports anonymous browsing, meaning anyone can browse the plans available on the website without creating an account or sharing personal information, according to Eric Masten, director of communications for the Door to HealthCare Western Maryland, a connector organization that provides enrollment assistance for residents in six western counties, including Carroll. People browsing can enter in a real or hypothetical income level and family size to get estimates of both insurance costs and any subsidies that might be available.

Subsidies come in the form of federal tax credits, according to Andrew Ratner, director of marketing and outreach for the Maryland Health Connection, and those who qualify can choose to either pay the full price of their insurance plan and receive the tax credit in April, or have the credit applied to their premium each month to reduce the cost of their payments.

Some people can also qualify for cost-sharing reduction discounts, funded by the federal government, which lower the out-of-pocket cost of co-payments and deductibles, according to information Ratner provided; such reductions, however, are only available on silver plans.

To see what this looks like in practice, the Times looked at the anonymous browsing results for three hypothetical insurance seekers: the Young Invincible, a 25 year-old single person; the Family of Four, two parents in their mid-30s with two young children; and the Empty Nesters, a couple in their early 60s, looking at retirement but not quite eligible for Medicare. None of these hypothetical people are smokers and none are pregnant.

The Young Invincible

Those younger than 26 have great leeway to stay on their parents' insurance, Ratner said, "even if they are married, not living with their parents, attending school, not financially dependent on their parents, or eligible to enroll in their employer's plan."

There might be circumstances however, in which 25-year-olds might have to choose a plan for themselves, such as if their parents choose not to include their child on their plan, or if the 25-year-old simply wanted to go it alone, though Ratner noted that he or she cannot be claimed as a tax dependent in order to do so.

Anonymous browsing brought up four catastrophic plans available to a 25-year-old making $24,000 per year, or between $11 and $12 in hourly wages. The least expensive plan was BlueChoice Young Adult, which had a monthly premium of $104.93 and an annual deductible of $6,600. The most expensive, the Choice 6350-1 plan, had a $203.82 monthly premium and $6,350 deductible. Neither plan covered any portion of doctor or emergency room visits until the deductible was met.

Even the invincible youth might consider checking out a plan with a few more features, however, and a search of bronze plans for the same hypothetical 25-year-old brought up a BlueChoice HSA Bronze $6,000 plan that had a $72.78 monthly premium, with no emergency room or primary care co-pays after meeting a $6,000 deductible.

The Evergreen Health POS Bronze 4500 plan meanwhile, had a $105.93 monthly premium, a $4,500 deductible and $20 co-pay for primary care visits.

Why are the costs for bronze plans lower or virtually equivalent to those of the catastrophic plans that are supposed to be cheap and lean? According to Ratner, it's because at $24,000 in income, a 25-year-old qualifies for subsidies.

"Subsidies cannot be applied to a catastrophic plan, so that could make the out-of-pocket cost of a bronze plan lower, after the subsidy is applied," he said. "Catastrophic plans mainly just protect you from high medical costs and may not offer all the benefits of other plans."

Masten said this difference highlights why it's worth it for anyone considering purchasing insurance to take advantage of the anonymous browsing feature to see what is available.

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"There is a whole range of possible options both in terms of plans and coverage, even within the metal levels, and of course once financial assistance comes into play," he said. "Any one of those plans could become affordable based on an individual's health and financial situation."

The Family of Four

In browsing for a family of four, we assumed there were two parents, both 35, and two children, ages 7 and 5, and then looked at their options at three income levels.

At an annual household income of $46,000, the website calculates that $202.15 in subsidies would be available for the family, and furthermore, the two children might be eligible for coverage under Medicaid. One of the plans available at this income level was the Kaiser Permanente Silver 1750, which had an estimated monthly premium of $230.77 — after application of the subsidy — a $1,000 deductible and 10 percent co-insurance after meeting that deductible.

Increasing the family's yearly income to $70,000, however, makes those subsidies drop to zero, though the children are still eligible for the state- and federally funded Maryland Children's Health Program, which provides benefits for children 18 and younger whose parents earn too much to qualify them for Medicaid coverage, according to the program website.

Silver plans for the family would now range from the BlueChoice HSA Silver, with a $429.76 monthly premium, $2,600 deductible and $12,700 out-of-pocket expense cap, to the Silver Choice 2500-1 plan, with its $628.84 premium, $12,700 out-of-pocket maximum and $2,500 per person deductible.

Increasing the family's yearly income again to $83,155 — the median household income in Carroll County, according to the U.S. Census Bureau — the true cost of plans available through the Maryland Health Connection without subsidies becomes more clear.

A Kaiser Permanente Silver HSA plan, which includes dental and pediatric dental coverage, would cost $657.88 in monthly premiums, feature a $3,500 deductible and 25 percent co-insurance after meeting the deductible.

The Empty Nesters

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The Empty Nesters are a nonsmoking couple whose children are grown and who are preparing for retirement but who do not yet qualify for Medicare, being 62 years old.

Perhaps they have scaled back to one income and are making $56,000 annually, in which case anonymous browsing predicts they would be eligible for $571.69 in monthly subsidies.

They could purchase the BlueChoice HSA Silver plan with a $438.71 monthly premium — after application of the subsidy — a $2,600 deductible and $30 primary care co-pays.

If the Empty Nesters expected they would be going to the doctor a lot, they could go for a platinum plan, such as the Evergreen Health POS, with no deductible, a $20 primary care co-pay and a $3,600 out-of-pocket maximum. The premium would be $1,012.35 per month, after subsidies.

As with the Family of Four, the Empty Nesters' situation changes as their income increases. If their income is $83,155 per year, the subsidies disappear, and a silver plan such as the BlueChoice HSA would run $1,010.4 per month with a $2,600 deductible, $30 co-pay after meeting the deductible and a $12,700 cap on out-of-pocket costs.

These scenarios are only a small sample of the possible real-life situations of Carroll residents who need health insurance. Brian Mattingly, director of the Door to HealthCare Western Maryland, said anyone considering purchasing health insurance should go to marylandhealthconnection.com and see what might be available based on their unique life circumstance.

"I would encourage anyone to [browse anonymously] whether they would enroll themselves or seek assistance, simply because it will really empower them to make the best decision," he said.

Reach staff writer Jon Kelvey at 410-857-3317 or jon.kelvey@carrollcountytimes.com.

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