Some consumers who buy coverage on the health insurance marketplaces in 2017 could see their out-of-pocket expenses reduced significantly under a federal proposal to create standardized plans, according to Avalere.
The rise in popularity of high deductible health plans has left 20 percent of insured Americans unable to afford their medical bills, according to Kaiser Family Foundation and New York Times. With a typical silver plan deductible of nearly $3,000 in 2016, a relatively healthy person may pay hundreds of dollars in monthly premiums, yet still owe the entire bill for most medical services he or she receives during the year, reports Kaiser Health News.
The increased unaffordability of healthcare plans has led the federal government to consider new ways of designing and delivering healthcare payment plans. Below are six things to know about federally proposed standardized health plans.
1. The government has proposed creating six plan options at the bronze, silver and gold metal levels, each with standard deductibles, maximum out-of-pocket costs and copayments.
2. For consumers in the gold and silver level plans, individuals would make a flat copayment for physician visits and prescription drugs instead of owing the entire amount until their deductible is met. This is known as first-dollar coverage.
3. The federal proposal would affect benefit standards for plans starting in 2017.
4. The change could benefit both those with fewer healthcare expenses as well those with pricey medical conditions, according to the Avalere study. "In particular, first-dollar coverage may be appealing to some healthier consumers who are paying a monthly premium but never meet their deductible and therefore are not seeing the value of their insurance," said Avalere senior vice president Caroline Pearson.
5. Currently, 64 percent of silver plans cover specialist visits and 74 percent cover specialty drugs only after a patient's deductible is met, according to Avalere.
6. "Introducing standardized benefit designs into the federal exchange builds on the existing approach of many states," said Avalere's vice president Elizabeth Carpenter. "While standard benefits limit flexibility for plans and could increase costs, the structure may appeal to some consumers by making it easier to compare plans and choose insurance."