More exchange PPOs forgoing out-of-network cost limits

An increasing number of preferred provider plans, or PPOs, offered in the federal exchange are forgoing annual caps on how much policy holders paid toward out-of-network care, leaving policyholders facing unlimited financial exposure (Source: “2016 PPO Plans Remove Out-Of-Network Cost Limits, A Costly Trap For Consumers,” Kaiser Health News, Dec. 3, 2015).

Forty-five percent of the silver-level PPO plans coming to the market for the first time in 2016 provide no annual cap for policyholders’ out-of-network costs, an analysis by the Robert Wood Johnson Foundation finds. Not having a cap could lead to tens of thousands of dollars in bills for patients who are hospitalized or treated by providers who are not part of the plan’s network.

This year, 14 percent of existing silver-level PPO plans had no annual ceiling on out-of-network care. When new plans coming to the market and the existing plans that are continuing are factored together, that percentage will double to 30 percent of silver-level PPOs with no out-of-network financial cap in 2016, the analysis finds. Silver level plans, which are the second-lowest cost plans, are the most commonly purchased in the marketplace.