美国国家公共电台 NPR Consumers Hunting For Health Insurance Find High Prices — And Some Great Deals（在线收听）

STEVE INSKEEP, HOST:

Tomorrow is the deadline in most states for people to buy health insurance on the Affordable Care Act exchanges - a law still in place despite Republican efforts to dismantle it. So as open enrollment ends, we have reporters in two states, Maryland and Tennessee, reporting on how the sign up is going. And we start with Selena Simmons-Duffin in Maryland.

SELENA SIMMONS-DUFFIN, BYLINE: Gene Kern is 63 and lives in Frederick, Md.

GENE KERN: And I spend most of my day chasing my dog around the house.

SIMMONS-DUFFIN: He retired early from Fujifilm. He sold professional videotape.

KERN: When the product became obsolete, so did I, and that's why I retired.

SIMMONS-DUFFIN: He's been an enthusiastic enrollee in Maryland's health exchange since it started in 2014. But this fall, he received a letter from his insurer. It said that for 2018, the cost of his premium was rocketing up from $800 a month to $1,300 a month. Although premiums went up in many places for 2018, most people won't actually have to swallow those higher costs because subsidies went up, too. Gene Kern is one of the unlucky ones.

KERN: Because of my income, I am slightly above the 400 percent overall poverty level, and as a result, I get no subsidy from the government.

SIMMONS-DUFFIN: So for next year, he's downgrading.

KERN: It's only an HMO plan, and even then, it's going up to $892 a month.

SIMMONS-DUFFIN: That's still more than 20 percent of his income, which is fixed.

KERN: It's the best I can get.

LOUISE NORRIS: Rates are high. There's no way to sugarcoat that.

SIMMONS-DUFFIN: Louise Norris is a health insurance broker and analyst in Colorado. But for people like Kern, she warns against the temptation to get a plan that doesn't comply with the minimum standards set out by the ACA.

NORRIS: It seems like a good deal because it's cheap, but then, you know, you find yourself ending up being that person who has a heart attack and needs triple bypass, and hundreds of thousands of dollars later, you wish you had the ACA-compliant plan.

SIMMONS-DUFFIN: Gene Kern feels lucky in one way. Medicare is just two years out. Until then, he's just glad to have insurance and the peace of mind that gives him. I'm Selena Simmons-Duffin in Frederick, Md.

BLAKE FARMER, BYLINE: I'm Blake Farmer in Nashville, Tenn., where people who buy insurance on the federal marketplace were pretty nervous. This year, state regulators approved average rate increases ranging from 20 to 40 percent. Brenda Linn is already paying $750 a month just to cover herself. So the retired kindergarten teacher and her husband logged on to healthcare.gov to see how bad the damage was going to be.

BRENDA LINN: And I'm like, Dave, this has to be a mistake.

FARMER: For her silver-level plan, the quote was less than $5 a month. A slight loss of income made her eligible for a subsidy.

LINN: Because we didn't qualify last year, I wasn't really that hopeful.

FARMER: A large majority of marketplace shoppers do get a break, and the subsidies are considerably larger this year. That's because the subsidies rose along with any premium increases. Volunteer application assistant Tony Garr says more than ever this year, people should shop around on the exchange to see what kind of subsidies they may be eligible for.

TONY GARR: Generally speaking, they will find out that help is there.

FARMER: Those who've gotten a break in the past are finding that it goes further. Daniel Prestwood is self-employed. He cleans fish tanks around Nashville.

DANIEL PRESTWOOD: This time of year, winter, when you're running your heat a lot, it makes the water evaporate more.

FARMER: Prestwood says he found a better plan and still had his monthly premiums drop from $300 to $200. He tries not to get too frustrated by the political wrangling around health care.

PRESTWOOD: All I know is that for 2018, I'll have a good health care plan in place, and that's the best I can hope for at this point.

FARMER: While enrollment for most states ends Friday night, eight states and the District of Columbia have slightly longer for folks to sign up. For NPR News, I'm Blake Farmer in Nashville.

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INSKEEP: That story is part of a reporting partnership with NPR, local member stations and Kaiser Health News.

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