Federal marketplace changes could drop out-of-pocket costs

Some consumers who buy coverage on the health insurance marketplaces in 2017 could see their out-of-pocket costs drop significantly under a federal proposal to create standardized plans, a recent analysis found (Source: “New Federal Standards For Marketplace Plans May Reduce Out-Of-Pocket Spending,” Kaiser Health News, Jan. 22, 2016).

The government wants to create six plan options at the bronze, silver and gold metal levels, each with standard deductibles, maximum out-of-pocket spending limits and copayments or coinsurance for various services. In addition, primary care and specialist doctor visits and prescription drugs would not be subject to the deductible in the standard silver- and gold-level plans.

Consumers in those plans would generally make a flat copayment for those services from the beginning, such as $30 for a primary care visit, instead of owing the entire amount until they meet their deductible for the year.

The change could benefit people who have few health care expenses, as well as those with pricey medical conditions who usually meet their annual out-of-pocket spending limit, to analysis from health consulting firm Avalare.