Premiums will likely continue to go up in the coming years for plans on the Patient Protection and Affordable Care Act state and federal marketplaces, but for many consumers, the out-of-pocket costs may go down.

A new study by Avalere, a health care consulting firm, suggests that proposed new standards for PPACA plans would “increase coverage of certain services and drugs, while lowering out-of-pocket costs for many consumers” if they take effect in 2017.

In particular, the feds are proposing devising six “standard plans” that ideally would be available to every marketplace consumer. The six plans would include one at the “gold” level, four at the “silver” level and one at the “bronze” level.

The idea is to offer a degree of certainty to consumers who are overwhelmed by the choices available on the marketplace. In addition, even if the standard plans have high deductibles –– like many others on the marketplace –– they would help pay for more services before the consumer meets the full deductible. Instead, they would likely impose co-pays for specialist visits or prescription drugs.

The proposal is ostensibly aimed at the legions of frustrated consumers who don’t feel like they get much out of the high-deductible plans they purchased on the marketplace. According to the study, 64 percent of silver level plans do not cover specialist visits until after the deductible is met, and the average deductible is nearly $3,000.

“Standardized benefit designs might increase access to care for certain services and drugs by providing first-dollar coverage,” said Caroline Pearson, senior vice president at Avalere. “In particular, first-dollar coverage may be appealing to some healthier consumers who are paying a monthly premium but never meet their deductible and therefore are not seeing the value of their insurance.”

Avalere notes, however, that lower payments for medical services might increase use and lead to even higher premiums. Insurers aren’t known to simply lower costs out of sympathy.

Instant Insights /

New PPACA standards could lower out-of-pocket costs

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