Obamacare health plans have been getting a bad rap this year. Critics
say the premiums are too high, the out-of-pocket costs are out of
control, and the requirements and red tape are too thick.
But now the Obama administration is pushing back.
A
study released Tuesday by the Centers for Medicare and Medicaid
Services argues that the cost-sharing isn't nearly as heavy as previous
analyses have shown, because most consumers get subsidies that limit
their deductibles and copayments.
"This comprehensive analysis makes clear that two key misconceptions about the market are incorrect," said Christen Linke Young, principal deputy director of the Center for Consumer Information and Insurance Oversight at CMS.
She said those misconceptions are that deductibles are very high and that out-of-pocket costs for consumers are out of control.
The
median deductible that consumers actually pay for Obamacare health
plans is $850 this year, $50 less than last year, the CMS report shows. A
deductible is the amount of health costs a person must cover before
insurance kicks in.
The CMS report contrasts with a Kaiser Family Foundation analysis
from November 2015 that shows the average deductible for a midlevel
health plan, including prescription drugs, is $3,064. That survey didn't
take into account the financial assistance that about 60 percent of
Obamacare customers get to cover health costs.
"This shows that the marketplace is more attractive to
lower-income people," says John Holahan, a fellow in health policy at
the Urban Institute in Washington.
He said for people with
higher incomes, health plans sold on the government run exchanges are
often still out of reach because of high premiums and out-of-pocket
costs. The report found that 17 percent of people are paying deductibles
of more than $5,000 per year.
People whose incomes are 250
percent of the federal poverty level or below qualify for "cost
reduction subsidies" under the Affordable Care Act. These subsidies are
designed to protect lower-income consumers from unexpected high costs
after they buy insurance.
Young says that level can reach families whose incomes are as high as $60,000 a year.
"We're really not talking about the lowest-income enrollees," she said on a conference call with reporters.
The CMS report also argues that the health plans are less expensive than the public perception
because many services come free to patients even before they meet their
deductible. The plans cover annual checkups and vaccines for children
and cancer screenings for adults with no copayments. Most also cover
primary care visits for adults, most prescription drugs and some
specialist visits — with a copay, but before a patient meets a
deductible.
"They are able to get the basic services they need without even thinking about the deductible," Young said.
http://www.npr.org/sections/health-shots/2016/07/12/485695941/hhs-report-says-obamacare-plans-are-cheaper-than-they-look
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