A new analysis from HealthPocket of early health insurance rate filings finds that Bronze Plans, the least expensive plans under the Affordable Care Act (ACA), have higher out-of-pocket costs for consumers compared to current plans in the individual and family insurance market.
While most states have yet to publish their rates, Bronze Plan filings from California, Connecticut, Ohio, Oregon, Rhode Island, Vermont, and Washington indicate that for these entry-level plans consumers may pay more in deductibles, co-payments and co-insurance for their medical services than they do now, according to HealthPocket.
Based on a review of over 9,500 health plans in the current individual and family health insurance market, HealthPocket estimated co-payments for doctor visits at $28 on average. In comparison, Bronze Plans averaged a $41 co-payment — an increase of 46 percent. The lowest Bronze Plan co-payment for a doctor was $15 and the highest was $60. For doctor visits where a co-insurance fee is charged instead of a flat-fee co-payment, the current national average is 24 percent. Bronze Plans that charge co-insurance averaged 27 percent, an increase of 13 percent.
The analysis also revealed that changes are coming to how deductibles work for doctor visits and that there will be significant increases in average plan deductibles. In the current pre-reform market, 37 percent of health plans include doctor visits as part of the deductible. For the new Bronze Plan filings, 84 percent had doctor visits subject to the deductible. For Bronze Plan consumers, this means they are likely to be charged the full amount for some doctor visits until they have met their plans' deductible. In California, however, it is standard plan design that the deductible will not be applied for the first three doctor visits. In the seven states where HealthPocket examined rate filings, the current average medical deductible was $3,589. In those same states, the Bronze Plans' average medical deductible was 26 percent higher at $4,509.
"We know that consumers' number one concern about health insurance is what they will have to pay for it," said Kev Coleman, head of research & data at HealthPocket, in a news release. "People shopping for insurance need to worry about two things: the cost of their monthly premium and what out-of-pocket costs they face. By considering both factors together rather than in isolation from one another, consumers can make the best financial decision for their healthcare."
HealthPocket selected the Bronze Plan as the focus of its investigation since it is the least expensive level health plan within the ACA and, accordingly, expected to be the most popular among cost-conscious consumers. For most people without group insurance from an employer or other group, the Bronze plan is the minimum health insurance plan in which they can enroll that will satisfy the ACA's mandate for people to purchase health insurance.
HealthPocket derived study results from qualified health plan rate filings within the individual and family health insurance market for the calendar year beginning Jan. 1, 2014. Data on cost-sharing for currently available health plans was collected on June 11, 2013 from 9,727 health plans within the individual and family health insurance market.