Throughout the new Health Insurance Exchanges, health plan offerings vary in premiums, cost sharing, and provider networks. As the Affordable Care Act’s radically new regulatory and financing framework plays out in the insurance market and with consumer and employer decisions, we can expect considerable change and variability from 2014 through at least 2016.
Valid and reliable data on the impact of Obamacare is still hard to come by. Early information is mixed, suggesting a spike in health costs, declining consumer choice in providers as health plans narrow networks, increases in out-of-pocket costs, a significant growth in Medicaid rolls, some newly insured through the exchanges, and many of the already-insured buying different plans in and outside the exchanges. Signups during the first open enrollment period for exchange coverage indicate that crowd out may be substantially higher than the 30% level assumed by the Congressional Budget Office (CBO). Large and midsize employers continue to noodle on whether, how, and when to move covered employees to public or private exchanges. With several key ACA requirements now delayed until after the November 2014 mid-term elections, late 2014 and 2015 will be lively.
Meanwhile, health plans are finalizing premiums and cost sharing for 2015. Much of this may not be known publicly until August, after regulators review and approve rates and federal and state exchanges certify plans for the 2015 contract year. It will certainly be interesting to compare plan participating, premiums, cost sharing, and provider networks between 2014 and 2015.
Online Resource for Health Plan Premiums and Cost Sharing in 2014:
For fellow data junkies and the simply curious, there is online information on health plan premiums and cost sharing for 2014 in the federally-run Health Insurance Marketplace. The dataset at data.healthcare.gov provides details on every qualified health plan (QHP) participating in the federal Health Insurance Marketplace (healthcare.gov). The information available includes:
- Issuers name and marketing name of the product(s).
- Plan type (typically, HMO, PPO, or POS).
- State, county, and rating area.
- Website addresses for plan brochure, summary of benefits, provider network, and drug formulary.
- Mental levels offered – bronze, silver, gold, and platinum.
- Premiums for a range of scenarios for each mental level and plan type offered:
- Single adults without children. For adults, the ages shown for premium scenarios are 21, 30, 40, and 50.
- Children only.
- Couples without children.
- Individual adults with children (1, 2, or 3 or more children).
- Couples with children (1, 2, or 3 or more children).
- Cost sharing scenarios for each mental level and plan type offered, with breakdowns showing cost sharing for individual coverage and family coverage. This includes:
- Annual medical deducible and annual prescription drug deductible.
- Maximum out-of-pocket (OOP) for medical coverage and maximum out-of-pocket for drug coverage. For 2014, the annual total OOP limits for individual and family plans are $6,350 and $12,700, respectively. Given these limits, QHPs with lower actuarial values may use the OOP limits to also establish deductible levels.
- Copayments or coinsurance required for primary care physician visits, specialty visits, emergency room visits, and inpatient hospitals stays.
- Copayments or coinsurance required for prescription drugs – generic drugs, preferred brand drugs, non-preferred brand drugs, and specialty drugs.
The website allows you to filter the data set to, for example, focus on a particular state. You may also download the data in a variety of formats, including Excel, to play with to your heart’s content.
Fact Sheets on Florida, Illinois, Georgia, Iowa, and Delaware Health Plan Markets for 2014:
Analyzing the data available on data.healthcare.gov, the Congressional Research Service (CRS) has created fact sheets on premiums and cost sharing of qualified health plans participating in several states. CRS, which is part of the Library of Congress, creates reports for Congressional offices but does not make it its work available to the public. We have to ask your Senator or Member of Congress or wait for Congressional offices to leak the reports and issue briefs to the web.
So far, CRS fact sheets summarizing exchange plan costs are available for five states. Click the state name below to open a copy of the fact sheet in PDF:
Enjoy the data surfing!