Shift to high-deductible bronze plans spells trouble for primary care

A doctor examining a patient's eyes
More consumers are opting for high-deductible bronze plans, most of which don't include primary care coverage. (Getty/monkeybusinessimages)

A recent surge in popularity of high deductible, bronze-level plans in the marketplace exchanges could translate to a decreased dependency on primary care.

Research released last week by the Robert Wood Johnson Foundation found the gap in coverage between bronze and silver plans is wide enough that some low-income patients could skip primary care altogether. 

Bronze-level plans make up 29% of the marketplace exchanges, up from 23% in 2017. Silver plans, most of which include cost-sharing for primary care visits before a patient's deductible is met, fell from 72% to 63%.

The shift to these high deductible plans means many patients are required to pay out of pocket for primary care visits until they meet their deductible, which can total $6,400. While a copay typically reduces such a visit to around $20, uninsured patients can be charged between $150 to $200 per appointment, according to John Hopkins Bloomberg School of Public Health

As a result, some patients may forego primary care altogether to save money during a time when the Economic Policy Institute says income growth remains low.

The level of primary care coverage also depends on the state. For example, in Minnesota, 67% of bronze-level plans don’t include predeductible primary care, while that number reaches 88% in Louisiana, according to the RWJF report. Overall, 60% of bronze plans don't include predeductible cost-sharing for primary care. 

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A dependence on primary care is typically greater in rural areas where providers and specialists are few and far between and costly hospital visits are sometimes the only alternative. 

The popularity of bronze-level pans was likely driven by President Donald Trump's elimination of cost-sharing subsidies coupled with increased rate hikes, which resulted in insurers stuffing rate increases into silver-level plan premiums.

If cost-sharing is not addressed this year, it could lead to an even greater shift to bronze plans for 2019, as consumers continue to try to find ways to reduce out-of-pocket costs. A proposed expansion of short-term plans and a repeal of the individual mandate could also be contributing factors during next year's open enrollment period.