![]() Of 14 plans examined in Chicago, for example, only one required the deductible to be fully met before the consumer could see a primary care doctor for a small copayment. The average bronze deductible there was $5,689.Īmong silver plans, the analysis showed that far more provide some coverage before the deductible is paid. In Philadelphia, by contrast, 33 percent of bronze plans require policyholders to pay the deductible first, the smallest percentage among the cities studied. Charges could also apply if, during a preventive care visit, the patient is also treated for a medical condition or a minor injury. But prevention services do not include treatment for an illness, such as the flu. Those include some vaccinations, mammograms and other cancer screenings, contraception, including birth control pills, and periodic physicals. Gold and platinum plans were not included in the eHealth/KHN analysis because they generally cover more services with less cost-sharing by consumers.Īll new plans must cover some defined preventive services with no copayment by the consumer and without having to meet the deductible first. Under the law, Congress granted insurers leeway in how they design their plans, so long as bronze plans cover at least 60 percent of the costs of a typical policyholder, silver plans cover 70 percent, gold plans cover 80 percent and platinum plans cover 90 percent – with consumers on the hook for the remainder. (KHN is an editorially independent program of the foundation.) More than three-fourths of the insurance plans offered to Americans with coverage through their jobs pay a substantial chunk of the cost of doctor visits without the worker having to meet the annual deductible first, according to the annual survey of employers by the Kaiser Family Foundation. Meeting the deductible before most coverage kicks in is common in the individual market, but differs sharply from job-based health insurance. The analysis included most or all of the plans available through the health law marketplaces in Atlanta, Philadelphia, Dallas, Tampa-St. Silver plans, which generally have higher monthly premiums, are more generous, with more than three-quarters paying for doctor visits before the deductible is met. A typical office visit can run $65 to $85, while more complex visits can cost more. Patients in those plans who haven’t yet met their annual deductible would have to pay the full cost of the visit, unless it was for a preventive service mandated by the law. But in seven major cities, half of bronze plans on average require policyholders meet the deductible before insurers help with the cost of a doctor visit, according to an analysis of data from online insurance broker for Kaiser Health News. There is no nationwide data on how many do that. But first-time insurance buyers may not realize they’re on the hook for additional costs before benefits kick in, and may choose a plan based solely on the monthly premiums.īronze and silver plans - which have lower monthly costs but typically, higher deductibles - are the most likely to require consumers to spend that amount themselves before the insurer pays any claims. ![]() Those who’ve bought their own insurance have always had to pay a set annual sum, called a deductible, before policies begin paying their claims. Experts worry that some enrollees will be discouraged from seeing doctors if they have to pay the full charge, rather than simply a copayment. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |