Review finds cost-sharing amounts likely to jump

Providers may have good reason to worry about a 2014 surge in patients covered by health plans with high deductibles and copays.

One of the first examinations of deductibles and copays in states where health insurance exchange plan rates have been filed found both types of cost-sharing amounts will jump from current levels. The review of exchange filings by HealthPocket in seven states—California, Connecticut, Ohio, Oregon, Rhode Island, Vermont and Washington—found that average copays in the individual market will jump 46% from a national average of $28 to $41 in the exchanges' lowest-cost bronze plans.

HealthPocket also found average deductibles will rise 26%, from $3,589 for current plans in those seven states to $4,509 in the new bronze-tier plans, the review found.

The cost of exchange plan deductibles and copays—which will be offset by subsidies for people earning less than 150% of the federal poverty level—has received much less attention than the cost of monthly premiums.

The deductible and copay increase doesn't surprise hospital payment experts, who have urged more public education on the issue, but it may come as a nasty shock to consumers who buy bronze- and silver-tier exchange plans on the basis of their lower premiums. On the other hand, benefits in the exchange plan also are likely to be richer than benefits offered by current individual-market plans.

“The thing that is certain is the monthly premium, and the other factors become much more obvious only when they start to access the system,” said Steven Zaleznick, director for consumer strategy and development at HealthPocket, which compares plans for consumers.

It remains to be seen how popular such high-deductible plans will be among exchange enrollees in January—and how popular they are after people gain experience with them.

Follow Rich Daly on Twitter: @MHrdaly