Average Out-of-Pocket Costs for Obamacare Plans

There are significant differences in out-of-pocket costs among the new ACA metal plans, according to a HealthPocket report. Deductibles drop more dramatically among metal plans than their differing actuarial values would suggest. When comparing the new Affordable Care Act health plans, consumers should factor in their expected healthcare use along with premiums. However, for those who need a specific doctor or hospital, it is important to note that annual out-of-pocket expense protections only apply to covered medical services delivered by in-network healthcare providers, said Kev Coleman, Head of Research & Data at HealthPocket.

Health plans under the ACA are differentiated by the percentage of medical costs that the health plan pays. The entry-level bronze plan covers 60% of enrollee costs; the silver plan covers 70%; the gold plan covers 80%; and the platinum plan covers 90%. However, when looking at the average deductible amounts for each of the metal plans, the differences were significantly larger than the 10% plan payment increments differentiating the plans.

HealthPocket found the average deductible amount for each of the four metal plans as follows:
* Bronze Plan: $5,081 for an individual/$10,386 for a family.
* Silver Plan: $2,907 for an individual/$6,078 for a family.
* Gold Plan: $1,277 for an individual/$2,846 for a family.
* Platinum Plan: $347 for an individual/$698 for a family

Last Updated 08/10/2022

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