Marketplace Customers Could See Higher Premiums, No Coverage For Out-Of-Network Care

Michelle Andrews, Kaiser Health News
Republished in The Lund Report, 1Oct. 27, 2015

When the health insurance marketplaces open on Sunday, consumers shopping for 2016 coverage may encounter steeper premium increases than last year and more plans that offer no out-of-network coverage.

According to an analysis released Monday evening by the Health and Human Services Department, the cost of the second-lowest silver plan in states using the federal marketplace will rise an average of 7.5 percent for 2016 coverage. Silver plans are the most popular type of marketplace plan. They pay 70 percent of medical costs, on average, leaving consumers to cover 30 percent. And premium tax credits that are available to people with incomes up to 400 percent of the federal poverty level — about $47,000 for one person — are benchmarked to the second-cheapest silver plan.

But the overall increase doesn’t tell the whole story for those shopping for insurance in the individual market — generally people who don’t get coverage through their work. Depending on the market, consumers may see larger or smaller increases or even declines in premiums. Premium changes for the second-lowest cost silver plan ranged from a 13 percent average decrease in Indiana to a 36 percent average increase in Oklahoma.