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Insurance premiums: Is $100 the next Obamacare hurdle?

It's all about the "Benjamins" for many current and potential Obamacare customers.

A customer sits with an insurance advisor with UniVista Insurance company, as he signs up for the Affordable Care Act, also known as Obamacare, before the February 15th deadline on February 5, 2015 in Miami, Florida.
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A customer sits with an insurance advisor with UniVista Insurance company, as he signs up for the Affordable Care Act, also known as Obamacare, before the February 15th deadline on February 5, 2015 in Miami, Florida.

A large majority of adults say "$100 a month or less" is the highest monthly premium they can afford to pay for health insurance in 2016, according to a survey released Wednesday.

The HealthPocket.com report found that 57 percent of respondents named that price range when asked about coverage affordability. The second-most common answer was $200 per month, which was the response of just 17 percent of respondents.

Cost, or perceived cost, is a prime reason that the remaining uninsured people give when asked why they do not purchase health insurance, even as the Affordable Care Act has brought the uninsured rate down to record lows. And Obamacare plans routinely cost more than $100 per month before the federal subsidies available to many enrollees are factored into the price.

Those subsidies are available to people with low and moderate incomes — but only if they buy plans on government-run insurance exchanges such as HealthCare.gov. About 85 percent of exchange customers qualify for such financial aid.

However, people with higher incomes, or those who buy outside the exchange, cannot get subsidies. And many uninsured people remain confused about how the subsidies work, or are unaware of their existence.

"The results of this nationwide survey have very different implications for those who are unsubsidized in their health insurance purchases, versus those who are subsidized," said Kev Coleman, head of research at HealthPocket.com. The insurance comparison site surveyed 1,137 people.

Coleman said that the average nonsubsidized plan on the federal HealthCare.gov exchange was $364 per month in 2015. The average premium for an individual receiving a subsidy was $101 per month, he said.

Federal officials noted that most customers on HealthCare.gov can and do buy plans that cost them less than $100 per month after subsidy. Almost 8 in 10 marketplace consumers had access to a plan for less than $100 after tax credits, according to a spokesman with the Department of Health and Human Services.

But Coleman, in a report on its survey, said, "For the subsidized, the average marketplace premiums align well with popular perspectives on health insurance affordability. For the unsubsidized, average marketplace premiums are above the highest affordable premium for more than 4 out of 5 people surveyed."

"In fact, the unsubsidized premiums are over two-and-a-half times more expensive than what most consumers claim is the maximum they can afford to pay for health insurance."

The HealthPocket.com survey also found that young adults ages 18 to 34 were more likely than others to say $100 or less was the most they could pay for health insurance each month. Young adults as a group are disproportionately more likely than others to lack insurance. And young adults are much desired by insurance plans because they are less apt to make claims for benefits even as they pay premiums that help cover others' medical coverage.

"These results also help explain why the government has had a tough time reaching enrollment targets for young adults," Coleman said.

The survey's results come less than two weeks before open enrollment in Obamacare plans is set to begin, on Nov. 1, and before final prices of 2016 policies have been announced.

Coleman noted that HealthPocket's research has previously shown that the prices of Obamacare plans would grow by an average of 12 percent, presubsidy, if they were approved as requested by insurers.

"The question is, how much of this is going to get approved," Coleman said.

The survey comes a week after the Obama administration announced a modest forecast for how many people are expected to be enrolled in health plans sold on government-run exchanges by the end of 2016.

The administration estimates that 10 million people will be enrolled by that time. That's less than 1 million more than the number of people it projects will be enrolled as of the end of this year. Overall, the administration expects that more than 1 in 4 eligible currently uninsured people will sign up on the exchange.

"We're starting this year with significantly fewer" eligible people, HHS Secretary Sylvia Burwell said last week. "And they're a little harder to reach."

An HHS official on Tuesday acknowledged to CNBC that many of the uninsured don't know about the financial assistance available to them and said the agency has focused for three years on "educating Americans about financial help" that they can get.

Nearly 80 percent of the uninsured have less than $1,000 in savings, HHS noted. And nearly 60 percent are confused about subsidies available to help lower the cost of insurance or don't even know that such assistance is available.

Federal officials, when asked about the HealthPocket.com survey, pointed to data that show how millions of people who purchase insurance on the federal Obamacare exchange pay less than $100 per month in premiums.

Of 7.7 million HealthCare.gov customers who were eligible for subsidies as of last spring, 77 percent could have selected a plan that cost them $50 or less per month in premium after their subsidy was factored in, according to the Centers for Medicare and Medicaid Services, which operates that exchange. A total of 38 percent of those eligible customers actually selected such a plan.

And 89 percent of subsidy-eligible customers could have selected a plan that would have cost them $100 maximum after the financial assistance, CMS said. A total of 63 percent of eligible customers actually selected such plans.

Officials also pointed out that of the remaining uninsured people who are eligible to buy coverage on the exchanges, 78 percent can receive at least a subsidy to offset the cost of their premiums, and almost half would also receive reductions in out-of-pocket costs. The remaining 22 percent of eligible uninsured earn too much to qualify for financial aid for exchange-sold plans.

Coleman, however, wrote in his report that the survey raises "questions not just about the affordability of privately purchased health insurance but about the mechanics of contemporary healthcare reform. The heavy reliance on selective premium assistance to manage insurance costs has had the unintended side effect of dividing health insurance consumers into two groups, the subsidized and the unsubsidized."

"For the subsidized, recent healthcare reform has produced privately purchased plans that are not only open to those with expensive preexisting conditions but are also largely affordable," he wrote. "For the unsubsidized, recent healthcare reform produced a health insurance market considerably more expensive than the market it replaced, with average unsubsidized premiums affordable to a small segment of the population."