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Health law coverage may track workplace cost shift

Published on NewsOK Modified: September 5, 2013 at 3:15 pm •  Published: September 5, 2013
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"A bronze plan is a very basic plan," explained Levitt. It "will enable consumers to pay very low premiums up front, zero in some cases. But when they actually need medical care, they will pay higher costs out of their own pockets." For the most part, you're stuck with the plan you pick until the next annual open enrollment season.

Job-based plans have been shifting costs to employees for some time. In 2009, when Obama took office, 22 percent of workers were in plans with an annual deductible of $1,000 or more for single coverage, according to Kaiser. By this year, the share had nearly doubled, to 38 percent, including 3 out of 5 employees of small companies.

Obama's law largely reflects what's already going on in the marketplace, but Pearson said over time it may accelerate the shift to plans with higher out-of-pocket costs.

Administration officials are pleased with the large number of low-cost options. Health and Human Services Department spokeswoman Joanne Peters said the administration is confident that consumers will be able to compare plans side by side in the new markets and make the right choices for themselves.

Avalere crunched the numbers on premiums filed by insurers in 11 states and Washington, D.C. Kaiser added another 6 states. Both studies included a mix of states running their own insurance markets and ones in which the federal government will take charge.

Under Obama's law, all plans on the new insurance markets must cover the same benefits, including preventive care at no charge to patients. Another similarity is a cap on total out-of-pocket costs at $6,350 for individuals, $12,700 for a family policy.

The main difference between plans is cost-sharing. Bronze plans cover 60 percent of expected medical costs, silver plans will cover 70 percent, gold will cover 80 percent and platinum 90 percent.

Midrange silver plans were considered the benchmark when the law was written more than three years ago. Lawmakers keyed the tax credits to the cost of the second-lowest-cost silver plan in a local area.

People with modest incomes may still come out ahead by sticking with a silver plan instead of going for bronze. That's because additional help with out-of-pocket costs such as copays will only be available to people enrolling in a silver plan.