* In many policies that do have out-of-pocket caps, not all services count toward the out-of-pocket limit, requiring workers to spend more before insurance coverage kicks in. For example, 32% of workers enrolled in PPOs are already in plans that do not count the annual deductible towards the out-of- pocket limit. 79% of workers in PPOs are in plans that do not count prescription drug cost sharing toward the out-of-pocket limit.
Such reductions in benefits will only increase under mandatory purchase of private health insurance. In Massachusetts, the "cheapest" plans carry $2,000 individual deductibles, co-pays of up to 35% for most health services, separate deductibles for prescription drugs and up to 50% co-pays. They cap only some out of pocket costs. Individuals in each of the following scenarios would be required to buy health insurance because plans are considered "affordable" under the state's formula:
* The state says a Boston couple in their late forties, with a $60,001 income, can afford premiums of $500 a month. The only plan available to them, for $468 a month (9.3% of their income), has no drug coverage, charges a $2,000 deductible and 20% coinsurance on most health services.
* A single 55-year-old making $51,000 a year in Boston would pay $4,510 in premiums for the cheapest plan available with prescription drug coverage. This is 9% of her income. The plan includes a $2,000 deductible, and co-insurance of 20% up to $5,000 a year. If her additional out-of-pocket costs next year are only the plan's $2,000 deductible, she would spend $6,510, or 13% of her income, on health coverage.
* A couple in their late forties living in Barnstable would pay a
minimum of $760 a month, or $9,121 a year, for the cheapest plan with
prescription drug coverage -- 11.4% of annual
|SOURCE Foundation for Taxpayer and Consumer Rights|
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