Obamacare plans are becoming more restrictive from the number of health providers they will cover, even as they increase out-of-pocket charges to an average of nearly $4,000 for the most common type of plans, a brand-new analysis finds.
The Avalere Health report comes two weeks before the close of open enrollment in 2018 individual insurance coverage plans sold on the federal Obamacare marketplace HealthCare.gov.
In 2015, 54 percent of insurance plans sold on of which marketplace had more restrictive networks, or the list of medical providers covered for customers.
although This specific year 68 percent of plans sold on HealthCare.gov were either a health maintenance organization or exclusive provider organization plan. Each have relatively restrictive or “narrow” networks.
in addition to next year, 73 percent of plans sold on HealthCare.gov — which serves residents of 39 states — will be either an HMO or EPO, according to the Avalere Health report issued Thursday.
HMOs in addition to EPOs typically only cover the costs of health services provided by doctors, specialists in addition to hospitals in their network.
If a customer gets care outside of the network, they usually have to personally pay all of the bill.
In contrast, preferred provider organizations (PPO) in addition to point of service (POS) plans usually have broader networks of providers, in addition to often cover a share of the cost of care obtained outside of their networks.
HMOs, which generally speaking hold the most restrictive networks, comprised 47 percent of HealthCare.gov plans in 2015 — although will make up 57 percent of the exchange’s plans in 2018.
In contrast, PPOs, which in general hold the least restrictive networks, were 35 percent of the exchange’s plans in 2015, although will make up just 21 percent of its plans next year.
Narrow networks have always been more common from the individual market plans sold on Obamacare exchanges than from the group market, where people who have insurance through a job are covered.
Caroline Pearson, an Avalere Health senior vice president, said more Obamacare plans are using narrow provider networks in an effort to limit how much they have to raise premiums, or the monthly cost of coverage to customers.
Insurers are often able to negotiate better prices through hospitals in addition to doctors if those providers are in narrow networks, because those providers will have less competition for customers’ business.
although Pearson noted, “These narrow network plans may come at a lower cost tag for consumers, although they may also limit consumer choice in addition to access to specialist care.”
In another effort to keep premium cost hikes under control, insurers are increasing deductibles for the most well-liked type of Obamacare plans.
The average deductible for so-called silver plans will rise to $3,937 in 2018 for plans sold on HealthCare.gov in addition to on exchanges separately run by the states of California in addition to brand-new York, Avalere found.
of which will be up through an average deductible of $3,703 for silver plans This specific year.
A deductible will be the amount of money a customer must personally pay out of pocket for many health services before their plan will start to cover the cost of care. Most customers on Obamacare exchanges buy silver plans, which cover 70 percent of health expenses.
Deductibles of the second-most well-liked type of Obamacare coverage, bronze plans, are decreasing, through an average of $6,014 This specific year to $5,873 next year, according to Avalere Health. Bronze plans cover 60 percent of their customers’ medical costs.
Elizabeth Carpenter, another senior vice president at Avalare, said of which the trend toward higher-deductible silver plans, as well as narrower networks, reflects insurers’ understanding of which customers “definitely value their monthly payment” costs.
“What you tend to see will be of which consumers choose a plan based on a monthly payment,” Carpenter said.
although “then they run into issues because the provider will be not in-network, or they have to come up with money to pay for a deductible of which they weren’t anticipating,” she said.