Whenever I write about Obamacare's expansion of health insurance, most of the e-mails I get from readers include some version of: Sure, the premiums may be low, but who can afford to see a doctor?
A survey released today by the Kaiser Family Foundation, tracking 2015 deductibles and copayments across most exchange plans, says those complaints are at least half right. For all but the most generous Obamacare plans, out-of-pocket payments are usually higher than for employer-based insurance -- in some cases, drastically so.
Some background: The metal levels in the charts below refer to how consumers are charged. For a bronze plan, the insurer is meant to cover 60 percent of the cost of essential health care, on average, leaving beneficiaries to cover the rest. For silver plans, it's 70 percent; for gold, 80 percent; and for platinum plans, 90 percent. As a result, premiums are generally lowest for bronze plans and highest for platinum.
So it's not surprising that out-of-pocket payments, also called cost-sharing charges, are higher for lower-cost plans. It is surprising just how high those payments are, even for middle-tier exchange plans, and also how high they are compared with the average plans that workers get through their companies.
Start with annual deductibles. For bronze plans in 2015, they're enormous -- $5,372, or about five times what the average person with employer-based individual coverage faced last year. More important, and potentially worrisome for the law's defenders: Average deductibles for silver plans (the most popular type of exchange coverage) are about three times as high as on employer plans. Even gold plans have slightly higher average deductibles.
Another way to compare cost sharing is to look at the out-of-pocket maximum: the most you'll need to pay during the year (after your premium) for core, in-network health services. Here, not only are 2015 bronze and silver plans about twice as high as for employer-based coverage last year; the out-of-pocket maximums for gold plans are also 50 percent more, on average.
Where most people feel the bite of cost sharing is when they head to the family doctor. On average, it will cost $13 more for that visit on a bronze plan in 2015 than somebody with employer-based insurance had to pay last year.
Those differences jump if you need to see a specialist. Copayments on a bronze plan are almost twice as high as for employer-provided plans last year, and more than 50 percent higher for silver plans.
But the most important reason to have health insurance is to protect you from the really expensive stuff -- mainly, the risk that you'll need to be hospitalized. Here, even the highest-value exchange plans impose higher copayments than the average employer-based insurance last year. For silver plans, that cost is about twice as high.
As usual with health care, the information above comes with caveats. Obamacare protects the poorest beneficiaries from these costs by subsidizing, on a sliding scale, out-of-pocket payments for people whose income is between 100 percent and 250 percent of the federal poverty line and who enroll in a silver plan.
For everyone else, you could argue that the exchanges are called "marketplaces" for a reason -- people who choose to buy anything less than platinum-level plans can see beforehand the copayments and deductibles they'll face, and make their decision accordingly.
But that assumes that insurance shoppers will take the time to read the details and understand them. It also assumes that people can do a good job of predicting the health-care services they'll need.
Even if those things hold true, cost sharing on the exchanges is still typically far higher than for the employer-based coverage that about half of Americans still have. Maybe that's a necessary price to pay for extending government-subsidized health care. But it also means that when people complain about the high cost of care, they're not wrong.
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