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'Silver' health plan out-of-pocket costs vary widely
By Insure.com staff

Health insurance out-of-pocket costs for doctor visits vary widely among silver plans offered through the Affordable Care Act marketplaces, even in the same states, according to a new report funded by the Robert Wood Johnson Foundation.

Copayments for doctor visits range from zero to $75 for primary care physicians, and from $10 to $150 for specialists nationwide. Coinsurance for primary care physician visits vary from zero to 50 percent and 8 percent to 100 percent for specialist visits.

Unlike most employer-sponsored health insurance, many of the marketplace plans make physician and specialist visits subject to an overall plan deductible, the report said. And median copays tend to be higher for marketplace plans than for work-based health plans.

The differences among plans can make shopping for health insurance complicated for consumers, the researchers concluded. Besides comparing premiums and deductibles, shoppers must consider copayment and coinsurance costs, as well as understand nuances of the health plan rules. They need to know how deductibles are applied and whether the network of providers includes a sufficient number and variety of doctors and hospitals.

"Depending on consumers' needs, these differences could matter a lot," Katherine Hempstead, who leads coverage issues at the Robert Wood Johnson Foundation, said in a press statement. "We need to find new ways to support plan choice so that consumers can make decisions that are in their best interest, even in the face of considerable complexity."
Breakaway Policy Strategies, which partnered with the foundation to conduct the analysis, looked at information on premiums, networks, deductibles, out-of-pocket limits and cost sharing for every 2014 silver plan offered through the marketplaces in all 50 states and the District of Columbia.

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