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Proposal To Add Skimpier Copper Plans To Marketplace Raises Concerns

Insurers and some U.S. senators have proposed offering less expensive, reduced benefits coverage, termed as “copper” plans on the health insurance marketplaces to encourage the uninsured that have not yet enrolled to buy. But consumer advocates and some policy experts say that focusing on reducing costs on the front end exposes consumers to unacceptably high out-of-pocket costs if they get sick.

“It’s a false promise of affordability,” says Sabrina Corlette, project director at Georgetown University’s Center on Health Insurance Reforms. “If you ever have to use the plan, you won’t be able to afford it.”

Coverage on the health insurance marketplaces now is divided into five types of plans that require different levels of cost-sharing by consumers. All the plans cover the mandated 10 essential health benefits, including hospitalization, drugs and doctor visits. Preventive care is covered without any cost-sharing.

Platinum plans pay 90 percent of medical expenses, on average; gold plans, 80 percent; silver plans, 70 percent; and bronze plans, 60 percent. Premium tax credits are available for people with incomes up to 400 percent of the federal poverty level ($46,680 for an individual in the 2015 plans). A catastrophic plan is available mainly to people younger than 30; it covers only limited services before the deductible is met and isn’t eligible for subsidies.

The proposals put forward by America’s Health Insurance Plans, a trade organization, and a group of senators led by Mark Begich (D-Alaska) would add a new level of coverage on the marketplaces. The copper plan proposed by Senator Begich and AHIP would pay 50 percent of covered expenses, on average, and be eligible for premium tax credits.

Because the proposed changes would require congressional action and because plans for the 2015 open season are already being set up, the earliest any of these new plans could be implemented would be 2016.

Some policy experts are skeptical that people will be enticed by another type of high-deductible/low-premium plan. They note that bronze plans weren’t particularly popular sellers on the marketplaces last year.

Only 20 percent of people who bought marketplace plans chose bronze-level plans, according to the Department of Health and Human Services. Two percent bought catastrophic policies. Silver plans were by far the most popular, selected by 65 percent of purchasers.

A plan that meets the health law’s coverage requirements but reduces the proportion of medical expenses insurers pay to 50 percent would require a deductible of about $9,000 per person, he says. Currently, deductibles for exchange plans can generally be no higher than $6,350 for individual coverage, the maximum out-of-pocket spending limit allowed under the law.

To be sure, health insurance affordability is a big concern. According to an April survey conducted for Enroll America, a health insurance advocacy organization, 48 percent of those who didn’t try to enroll said the No. 1 reason was the fear that they couldn’t afford coverage. Many didn’t know that financial help was available, however. Only 1 in 5 of those who sat out the first year of the ACA knew that premium subsidies were available for low- and middle-income people, the survey found.

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