Analysis from HealthPocket Inc., a health insurance information site for consumers, shows that health insurers have some work to do in the areas of out-of-pocket expenses and transparency. The analysis indicates that 38 percent of plans did not disclose their deductible within its annual out-of-pocket limits, concealing the full amount a person could pay if the “Summary of Benefits” was not read carefully. Once these deductibles are factored in, many plans are not compliant with the Affordable Care Act (ACA).
Under ACA provisions, taking effect in 2014, health insurers will be required to offer plans that fit within four levels of coverage: Bronze, Silver, Gold and Platinum. The ACA plans would cap current out-of-pocket costs for consumers to $6,250 per calendar year. And, currently, 36 percent of all health plans had higher out-of-pocket limits than what Bronze plan—the highest out-of-pocket option—will permit, according to HealthPocket’s recent analysis of 9,752 health insurance plans for individuals and families under the age of 65.
HealthPocket also analyzed location of these health plans and found that insurance coverage is inconsistent depending on where plans are sold. “The Affordable Care Act’s limit on out-of-pocket costs will have a highly regional impact, with consumers in states such as Vermont, Alabama, and Florida reaping the biggest benefits,” said Kev Coleman, head of research & data at HealthPocket. “While the average out-of-pocket costs limit nationwide falls within ACA guidelines, there are still thousands of plans that need to improve their out-of-pocket costs for 2014.”
While the national average—$6,019 for all plans —is below the Bronze Plan average, state averages varied from $3,192 to $10,013, with 15 states failing to meet ACA limits. Nationally, only 4 percent of plans examined had no limits on how much a consumer could pay annually in out-of-pocket spending for health care. For a state-by-state breakdown, click here.
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