SOURCE: AgileHealthInsurance.com

AgileHealthInsurance.com

October 19, 2015 09:00 ET

Out-of-Network Health Care Can Be Financially Devastating to Consumers

Uncovered Out-of-Network Care Can Cost Consumers Tens of Thousands of Dollars

MOUNTAIN VIEW, CA--(Marketwired - Oct 19, 2015) - With open enrollment approaching, AgileHealthInsurance.com has released a new study illustrating how a lack of out-of-network coverage within Obamacare exchange plans can cost enrollees tens of thousands of dollars if they do not remain in-network for their medical care.

Out-of-network care has been a growing consumer concern due to two factors: the prevalence of narrow network health plans within Obamacare and frequent restrictions on out-of-network care. A 2015 study by Avalere found that Obamacare plans sold on exchanges had 34 percent fewer health care providers in-network than commercial health plans sold off-exchange. An analysis by the research division of HealthPocket found that almost half of Obamacare plans on HealthCare.gov do not cover costs when enrollees get out-of-network health care, unless there is an emergency or the plan gives prior authorization for the health care.

Provider network restrictions can be financially devastating for consumers because they could have to pay their whole medical bill out-of-pocket if they choose to see an out-of-network provider. Given the possibility of catastrophic out-of-network medical costs, it is important for consumers to choose a plan with either a broad provider network or out-of-network coverage in case they develop a medical condition where the best care would be outside a narrow network.

"If you wait until something catastrophic happens medically, it's already too late," said Sam Gibbs, executive director of AgileHealthInsurance.com. "In times of extreme medical need, you want to have all possible options available."

Term health insurance plans are a compelling alternative for dissatisfied Obamacare consumers. Term insurance plans have broader provider network coverage than most Obamacare plans so enrollees can go to most doctors and still be covered. Out-of-network coverage is available in 100 percent of the term insurance plans sold on AgileHealthInsurance.com.

In 2012, the average cost for a surgical hospital stay was $21,200, according to the Agency for Healthcare Research and Quality. When the surgery is out-of-network, enrollees pay the full amount if they have an Obamacare plan without out-of-network coverage. However, with a comparable term insurance plan, the enrollee would pay $7,500 less, according to the AgileHealthInsurance.com analysis.

Term health insurance represents a distinct category of health insurance and does not provide identical coverage as Obamacare plans, and benefit and eligibility differences contribute to the cost savings observed. Consumers apply and, depending on their health status (including pre-existing conditions), they may or may not be eligible for specific plans. Consumer applications are approved or rejected based on health status (including the nature of pre-existing conditions). Additionally, with term health insurance, consumers may still be subject to the Obamacare Tax unless they qualify for one of several exemptions from the tax. The cost of term health insurance is so affordable that even for some consumers facing the tax penalty, the combination of penalty and premium is still less expensive than an unsubsidized Obamacare premium.
Read the article on AgileHealthInsurance's Learning Center at www.AgileHealthInsurance.com.

AgileHealthInsurance.com is the Internet's first site dedicated to helping consumers understand the benefits of term health insurance. These new plans are the culmination of extensive research on health insurance needs in the Affordable Care Act era, and consumers visiting AgileHealthInsurance.com will be able to find the lowest prices for the term health plans it offers. Additional information about AgileHealthInsurance can be found at www.AgileHealthInsurance.com.

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