Individuals and families looking for a federal health plan with low premiums may likely face annual deductibles averaging thousands of dollars, according to a new analysis of health plans sold on HealthCare.gov for 2015.
Indeed, previous reporting showed the majority of coverage offered by health insurers on the federally run Affordable Care Act exchanges will be considered as high-deductible health plans. The Internal Revenue Service defines a high-deductible plan for 2015 as one with an annual deductible of at least $1,300 on individual coverage and $2,600 for families.
Payers offer high-deductible coverage options to lower monthly premiums, but high cost-sharing before insurance kicks in could burden those who face unexpected illnesses or injuries.
The analysis by HealthPocket, a website that compares and tracks health insurance coverage data, found that average deductibles for bronze and silver plans—the most frequently purchased options on the ACA exchanges—are higher for 2015 compared to 2014.
For example, the average bronze-plan annual deductible for a single member is almost $5,200 next year, up 2% from 2014 and about four times higher than the IRS' baseline. Families with a bronze plan face an average deductible of more than $10,500.
For individuals buying a silver plan, the average deductible is about $2,900, and more than $6,000 for families. Gold and platinum plans, not surprisingly, have much lower deductibles but higher monthly payments. The average deductible for an individual platinum plan is $243, which is actually 30% lower than 2014.
Kev Coleman, head of research and data at HealthPocket, cautioned that averages are approximate figures. ACA plan deductibles vary widely among the different plans and depend on several external factors, just as premiums do.
Consumers shopping for health plans also have to weigh other cost-sharing charges, like copayments and coinsurance. HealthPocket discovered that coinsurance—an out-of-pocket cost in which an individual owes a percentage of a given healthcare service—was the most common form of cost-sharing for primary care and specialist visits. Bronze-plan coinsurance averaged 34% of the doctor visit, according to the analysis.
“For people who use healthcare more frequently, you really have to look at these out-of-pocket costs,” Coleman said. “They can really add up.”
Costly deductibles in bronze and silver plans may not be consumers' only concern, according to a separate analysis from Avalere Health. The consulting firm found that the average premium price of the lowest-cost silver plan, the most popular exchange plan, will rise 10% on average next year. Consequently, consumers could stand to benefit from shopping the exchanges to find lower premiums instead of simply re-enrolling, Avalere said.
Follow Bob Herman on Twitter: @MHbherman
