Erin Marshall | October 7, 2015
A study from Mountain View, Calif.-based HealthPocket shows 47 percent of Affordable Care Act plans on HealthCare.gov lack out-of-network coverage.
The study utilized government data on individual and family plans in the 37 states that use HealthCare.gov.
Here are three findings from the study.
1. The percentage of HealthCare.gov plans offering out-of-network coverage varied. Zero percent of plans in South Dakota offered such coverage, while 100 percent of the plans in Alaska, Alabama, Louisiana, Tennessee and West Virginia offered out-of-network coverage.
2. In the 37 states using HealthCare.gov, there were eight states in which less than 33 percent of plans covered out-of-network coverage. These states include South Dakota (0 percent of plans), New Jersey (10.2 percent), Nevada (14.6 percent), New Mexico (18.2 percent), Utah (18.5 percent), Maine (18.9 percent), Wisconsin (20.8 percent) and Texas (32.6 percent). In 13 states, less than half of the HealthCare.gov plans offered out-of-network coverage.
3. In comparison, original Medicare out-of-network coverage is significantly broader. Original Medicare enrollees can see any provider in the Medicare program. However, while out-of-pocket costs for in-network healthcare are limited by the ACA, the same protections against catastrophic medical expenses aren’t present in the case of out-of-network healthcare.
Source: Beckers