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Half of Americans with individual health plans could gain better coverage under the ACA
Date:5/25/2012

and exposed people to undue financial risk.

Average out-of pocket spending for households with individual plans was $4,127 per year, the study found. For households in the very highest category of spendingvery sick people who incur huge medical billsindividual insurance plans in the "tin" category left them with over $27,000 per year in out-of-pocket spending.

Group Health Insurance

The researchers also looked at group health insurance offered through employers in 2010, finding that more than 60 percent of Americans with group insurance had plans that fell into the "gold" or "platinum" category as defined by the health reform law. Gold plans or platinum plans cover 80 percent of more of health expenses on average, typically covering preventive services, such as screening for cancer, maternity care, and some mental health services, according to the study.

Gabel and his colleagues found that most people in group plans had better coverage and were more likely to be protected from high out-of-pocket medical expenses than those with individual health insurance. For example, the average household with an employer-based group health plan spent about $1,765 annually on out-of-pocket medical expenses, compared with $4,127 for those with individual coverage.

High-coverage group health plans mostly offered generous benefits and protection against catastrophically high medical bills, the authors found. But even these plans did not offer complete protection for the top 1 percent of spenderspeople in poor health. The top spenders in group plans paid on average $7,513 in out-of-pocket medical expenses on a yearly basis.

Transforming the Insurance Marketplace

The Affordable Care Act will transform the individual insurance market significantly, the authors said, adding that the post-reform individual insurance market will look nothing like it does today. In the past, insurance companies in the United States typicall
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Contact: Mary Mahon
mm@cmwf.org
212-606-3853
Commonwealth Fund
Source:Eurekalert

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