Tuesday, January 19, 2016

You've heard of narrow networks? Get ready for narrow deductibles

As deductibles and co-pays in health plans sold in the ACA marketplace continue to rise, HHS has stressed the fact that many plans offer significant services, such as doctor visits and drugs, that are not subject to the deductible.

In Southeast Pennsylvania (which includes Philadelphia), Independence Blue Cross offers a silver HMO plan that almost turns the whole concept of a deductible on its head. For a buyer who does not qualify for cost sharing reduction subsidies, the deductible is $1,500 -- relatively modest for a silver plan sold on the exchanges. But most services are not subject to the deductible. Here's the basic deal (for an unsubsidized 40 year-old in Philly):

The main services subject to the deductible are for inpatient hospital services:

Leaving aside issues of network adequacy (which I can't judge, but hc.gov's new provider-and-drug search tools may help assess), this really isn't a bad plan. Some silver plans with high deductibles -- e.g., Ambetter's -- offer a kind of Swiss cheese coverage: deductibles as high as $5000 or even, if I remember right, $6000, with an array of services not subject to it. In this plan, there's really only one hole -- for non-emergency inpatient hospital care -- and it's not that large.

Update: Lousie Norris tweets of another odd way to slice the silver plan holder's purported 30% share of costs -- worth a click-through to the article:
Seems much better than plans with $0 deductibles but $5,000 hospital copays...  http://www.oregonlive.com/finance/index.ssf/2015/12/a_few_thoughts_on_the_2016_ore.html

1 comment:

  1. This sounds good so I signed up my son for Care Connect which is owned by North Shore LIJ. We tried to find a psychiatrist which I didn't think would be a problem since there were 30 listed. Turns out these Psychiatrist only take patients who are in patient in their hospital. So while Care Connect looks good on paper when you try to use it you can't find a doctor. I wouldn't recommend Care Connect to any people in the area. Beware of Care Connect.