Affordability sways exchange customers

Price is driving the buying decisions of customers shopping for insurance in the individual marketplace. Many Americans--even those who qualify for government subsidies--are picking the cheapest exchange plans available, according to the Associated Press. That tendency has experts wondering if the public truly understands how health insurance works and the payment risks they assume by choosing low-end products.

Depending on individual circumstances, top-tier exchange plans aren't always the most expensive, as FierceHealthPayer previously reported. Further, if customers fail to anticipate their out-of-pocket costs at the point of sale, they may experience unwelcome surprises when bills arrive for claims not fully covered under the Affordable Care Act, the AP noted. And some hospitals worry that if underinsured Americans can't pay their medical bills next year, a problem healthcare reform was supposed to solve will linger.

The average deductible for a bronze plan is more than $4,300, according to an Avalere Health analysis of plans in 19 states. For a silver plan, it's about $2,500, and for a platinum plan it's $167. But only 14 percent of insured adults understand how deductibles work, the AP noted.

"The lesson [for the uninsured] is it's important to understand the total cost of ownership of a plan," Avalere Vice President Matt Eyles told the AP. "You just don't want to look only at the premium."

Another factor in the affordability equation: Even after buying a health plan, Americans may need to purchase supplemental coverage for benefit exclusions, such as vision services and adult dental care, neither of which are essential benefits under the ACA.

To show the added cost of these à la carte selections, eHealth analyzed about 39,000 individual market plans purchased in all states and the District of Columbia through the private health insurance exchange last year. The report, released yesterday, found individuals paid an average of $30 monthly for dental insurance, with 34 percent of PPO offerings featuring co-insurance at an average rate of 10 percent. Vision plan premiums averaged $18 per month.   

For more:
- read the AP article
- here's the eHealth announcement

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