Private insurance plans typically require some form of cost sharing, or out-of-pocket costs, such as copayments, coinsurance, and deductibles. This brief shows the cost sharing in plans sold to individuals through Healthcare.gov for 2016, with a focus on the variation in the ways plans may set cost sharing for services, such as physician visits, prescription drugs, and hospital stays.
According to a new Mercer study of 134 large employers (5,000 or more employees), 15% say that their onsite or near-site worker clinics will push them into the bracket where they will be required to pay the Cadillac Tax. But most of the respondents, 46%, either didn’t know how the clinics will affect their Cadillac tax status or didn’t think there would be an effect (28%).
According to HealthPocket.com, Bronze plan deductibles are rising on the Obamacare federal exchanges by an average of 11% to $5,731 and Silver Plan deductibles are rising by 6% to an average of $3,117. A survey by the Commonwealth Fund published last November found that three in five low-income adults and about 50% of adults with moderate incomes believe that deductibles are “difficult or impossible to afford.”
A recent National Bureau of Economic Research (NBER) study reveals that ObamaCare Marketplace plans are a bad deal, even for near-poor enrollees receiving large subsidies from the federal government. The study confirms that net premiums (after subsidies) were still several times what enrollees might have paid out-of-pocket for medical expenses had they remained uninsured.
From November 15 to December 15, a small business that purchases a plan in the Obamacare-created Small Business Options Program marketplace does not have to meet participation requirements, which require that businesses with up to 50 employees ensure that at least 75 percent of their employees enroll. The annual window comes at a time when small businesses haven’t taken to the Small Business Health Options Program, or SHOP, created to offer more plans for small businesses.
According to findings from the Kaiser Family Foundation, Americans who bought the least expensive plans on the most popular tier of insurance sold on HealthCare.gov will see premium increases an average of 15% next year unless they switch to a different health plan. In nearly three-fourths of the counties where consumers can purchase insurance through the federal exchange, the plan that was the lowest-price option this year will no longer have the least expensive premium next year.