One-third of payers exceed reform's out-of-pocket limits

More than one out of every three insurers has out-of-pocket costs for individual health plans that exceed new limits set under the reform law, according to a new study from technology company HealthPocket.

After analyzing government data on more than 9,700 health insurance policies, HealthPocket concluded 36 percent of individual plans surpass the reform law's $6,300 out-of-pocket cap.

Out-of-pocket costs averaged $6,019 in 2012, but varied from $3,000 to as much as $10,000 a year, according to the study. Insurers selling plans in 15 states exceeded the reform law's out-of-pocket limits, with insurers in five states--Alabama, Florida, Oregon, Vermont and Washington--surpassing that mark by 28 percent, Albuquerque Business First reported.

The study also found that 38 percent of insurers aren't complying with the reform law's requirement to include the annual deductible toward out-of-pocket costs, thereby preventing consumers from obtaining a clear picture of their financial responsibilities.

In response to the report, America's Health Insurance Plans said out-of-pocket maximum will affect consumers differently. "Someone with a high deductible, catastrophic plan today will see a much larger increase in premium than someone who already has a comprehensive policy through an employer or a lower deductible plan on the individual market," AHIP Spokesman Robert Zirkelbach told Kaiser Health News. "We will move to a system with a minimum level of coverage that is much broader than people have today. People will have more comprehensive health coverage, but it will be more expensive."

To learn more:
- here's the HealthPocket study
- read the Kaiser Health News article
- check out the Albuquerque Business First article

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