Benefit Shock at Obamacare Exchanges

If the Obamacare Marketplaces open on 10/1 as planned, the monthly price may be the easiest thing to understand.  Most people are not well versed in how health insurance benefits work, especially when reading it from a web site.

The rates that are being discussed in the news are generally for the lower cost plans, called Bronze or Silver.

Kaiser Health News describes the shock that consumers may feel when they discover what their money is actually buying.

Benefit Shock

Premium prices will be clear for shoppers in the marketplaces, but consumers won’t be able to assess the worth of these insurance policies until they grasp all the costs. Typical deductibles will be $2,000 or $5,000. In addition, patients will have to pay for part of their care even after they’ve satisfied their deductibles. For instance, Californians with a silver-level plan — a mid-level offering on the marketplace — will have to contribute $65 every time they see a specialist, $45 for a lab test, $65 for an X-ray and $250 if they go to the emergency room and 20 percent of the cost of hospitalization. Those co-payments continue until patients meet their maximum annual out-of-pocket amount, which generally will be $6,350 for individuals and $12,700 for families. The cheapest plans also may have the most limited groups of doctors and hospitals.

“The consumer is going to go to the exchange and find out for $2,500 a year they get a $2,000 deductible” for a policy they think they won’t really use, said Robert Laszewski, a former insurance company executive who is now a consultant. “The second thing they’ll find out is that their favorite doctor isn’t necessarily in the network, and to get a wide network it’ll be another $100 a month.



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