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Capped deductibles under the ACA impacts small business, according to survey

Ninety-six percent of Bronze plans exceed the deductible cap

Posted January 17, 2014

The Affordable Care Act (ACA) capped deductibles for small group health insurance plans at $2,000 for individuals and $4,000 for families. However, the Department of Health & Human Services announced in February 2013 that these deductible limits could be waived in situations where a limit prevented a health plan from meeting its ratio of insurance payments to enrollee out-of-pocket costs under the ACA.

Using government data on this year’s small group health plans from 32 states, HealthPocket, a website that compares and ranks health plans, analyzed the average out-of-pocket costs for the major health plan types and then determined what percentage of plans, if any, exceeded the original deductible limit for the small group market. For individual enrollees in small group health plans, the survey found that 35 percent of the plans studied had deductibles that exceeded the ACA limits. When analyzed by plan type, the survey found:

  • 96 percent of Bronze plans had deductibles over the $2,000 cap
  • 28 percent of Silver plans had deductibles over the $2,000 cap
  • 6 percent of Gold plans had deductibles over the $2,000 cap
  • 0 percent of Platinum plans had deductibles over the $2,000 cap

When examining deductibles for families, similar results were found with respect to the percentage of plans that exceeded the $4,000 family deductible cap.

“As the implementation of the Affordable Care Act gets progressively modified, we are finding a variety of downstream consequences for consumers,” said Kev Coleman, Head of Research and Data at HealthPocket, “In the case of the small group market, the conditional waiver has allowed the deductible for bronze plans to average over twice the amount of the original deductible limit.”


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