More plans raise roof on out-of-pocket costs

By Dan Cook

April 07, 2014 at 12:33 PM

Share & Print

As employers scour their health plans with an eye to controlling costs, they appear to be using an upper limit set by the Patient Protection and Affordable Care Act to adjust the out-of-pocket limits skyward.

Data released by insurance software developer Zywave revealed that, within Zywave's 50,000-employer customer database, 32 percent of plans had out-of-pocket limits of more than $5,000 in 2013. That's up from 20 percent in 2012.

This increase suggests that employers are using the PPACA caps as their target, Michelle Jackson, product director for Wauwatosa-based Zywave, said in an interview with the Milwaukee Journal Sentinel. The PPACA caps out-of-pocket spending at $6,350 for individuals and $12,700 for families in 2014.

Jackson said that out-of-pocket limits of more than $5,000 per employee verged on becoming catastrophic plans. So far, they aren't common, she said, but the data Zywave reported indicates that the trend will be in that direction.

Another trend cited by Zywave: health savings accounts, which offer more flexibility to those covered, have an increasing presence in health plans. Last year, 28 percent of plans in Zywave's data base had HSAs. That was up from 21 percent in 2012 and 16 percent in 2011.

Other notable nuggets from the study:

More than 40 percent percent of plans provided 100 percent co-insurance above the out-of-pocket maximum; and
The number of health plans with deductibles between zero and $49 for prescription drugs increased to 80 percent, up from less than 50 percent.

NOT FOR REPRINT