SOURCE: HealthPocket

HealthPocket

October 07, 2015 09:00 ET

Study: Almost Half of Obamacare Plans Lack Out-of-Network Coverage

In Comparison, Original Medicare Out-of-Network Coverage Significantly Broader

MOUNTAIN VIEW, CA--(Marketwired - Oct 7, 2015) - HealthPocket released a new study today that found nearly half of Affordable Care Act (Obamacare) plans on HealthCare.gov lack easily accessible out-of-network coverage. 53 percent of Obamacare plans on the HealthCare.gov marketplace had out-of-network coverage, leaving nearly half of Obamacare plans without out-of-network coverage outside unplanned medical emergencies or instances where the health plan is formally petitioned for out-of-network care and approves the request. The study of network coverage utilized government data on individual and family health insurance plans in the 37 states that use HealthCare.gov.

The percentage of Obamacare plans offering out-of-network coverage in each state ranged from 0 percent in South Dakota to 100 percent in Alaska, Alabama, Louisiana, Tennessee, and West Virginia. Across the 37 states that use HealthCare.gov, there were eight states in which less than 33 percent of Obamacare plans covered out-of-network medical bills: South Dakota (0 percent), New Jersey (10.2 percent), Nevada (14.6 percent), New Mexico (18.2 percent), Utah (18.5 percent), Maine (18.9 percent), Wisconsin (20.8 percent), and Texas (32.6 percent). In 13 states, less than half of plans offered out-of-network coverage.

In comparison, enrollees in original Medicare Parts A and B can see any healthcare provider that is enrolled in the Medicare program. In addition, while out-of-pocket costs for in-network healthcare are capped annually by the Affordable Care Act, the same protections against catastrophic medical expenses are absent in the case of out-of-network healthcare. For those consumers beset by serious medical conditions where the best care is out-of-network, a choice has to be made on whether to pursue that out-of-network care despite the financial implications or accept care in-network that will not include the best healthcare provider to treat the condition.

"Health insurance is only as good as the doctors and hospitals that accept it," said Bruce Telkamp, CEO of HealthPocket.com. "By this common sense standard, the lack of meaningful out-of-network coverage in many Obamacare plans brings up troubling questions for those enrollees whose health plan networks lack top hospitals or cancer centers."

HealthPocket.com is a free website that compares and ranks all health insurance plans, helping individuals, families, and small businesses to make their best health plan decisions. HealthPocket publishes health insurance market analyses and other consumer advocacy research. HealthPocket's research is nonpartisan and uses only objective data from government, non-profit, and private sources that carry no conditions that might restrict the site from serving as an unbiased resource. HealthPocket, Inc. is independently managed and based in Mountain View, California. Learn more at www.HealthPocket.com.

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