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PPACA and Deductibles: What the Plans Look Like

Posted in Plan Administration, Welfare Plans

I happened upon an article today where an insurance comparison website by a company called HealthPocket has compiled averages concerning the various metal plans available through the exchanges.  I thought I would share some of the details simply because I think it is important for employers planning their compliance package to be aware of what the metal plans look like on some specific issues so that they can understand how to compare what they may be offering to employees against what is available on the exchanges.

HealthPocket reports that these figures are averages as reported by the government based on 34 state exchanges:

Bronze:

  • Single Individual Deductible: $5,081
  • Family Deductible: $10,386
  • Annual Cap on Out of Pocket (OOP), Single: $6,267
  • Annual Cap, OOP, family: $12,569
  • Co-Pay, Doctor Visit: 30% of expense
  • Co-Pay, Specialist: 30% of expense

 Silver:

  • Single Individual Deductible: $2,907
  • Family Deductible: $6,078
  • Annual Cap on Out of Pocket (OOP), Single: $5,730
  • Annual Cap, OOP, family: $11,495
  • Co-Pay, Doctor Visit: $32
  • Co-Pay, Specialist: $56

 Gold:

  • Single Individual Deductible: $1,277
  • Family Deductible: $2,846
  • Annual Cap on Out of Pocket (OOP), Single: $4,081
  • Annual Cap, OOP, family: $8,649
  • Co-Pay, Doctor Visit: $24
  • Co-Pay, Specialist: $46

 Platinum:

  • Single Individual Deductible: $347
  • Family Deductible: $698
  • Annual Cap on Out of Pocket (OOP), Single: $1,855
  • Annual Cap, OOP, family: $3,710
  • Co-Pay, Doctor Visit: $16
  • Co-Pay, Specialist: $30

Obviously these components of coverage may vary by state and exchange plan offered, but for general comparison against what is available through employer sponsored coverage, employers can begin to get more of a feel for what some of the practical implications are for employees using the exchange.