Milliman: Insurance Exchange Plans Shifting Costs from the Healthy to the Chronically Ill

Actuarial studies of plans sold through health insurance marketplaces in some states found that many make consumers responsible for as much as 50 percent of the price of specialty drugs, which can cost $8,000 or more a month…

Researchers also say the higher rates help insurers bankroll low monthly premiums to attract healthy young enrollees…

Obamacare caps those expenses at $6,350 for individuals and $12,700 for families. But patient advocates say the spike in cost-sharing means chronically ill people could reach those caps quickly, in some cases within the first months of coverage. (Reuters)

Comments (22)

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  1. Ford says:

    So in a word, people will be paying more for their health bills.

  2. Charles M says:

    As in everything there are winners and losers. Some will see the benefits of Obamacare, some will suffer the consequences. How can we judge? The article talks about two individuals who were affected by the new law (a winner and a loser). One paid an outrageous amount of money for being uninsured, while the other one had the best deal and paid practically nothing for treatment. One party will highlight the situation of the individual who received the benefits. The other one will show the other side of the coin. And the problem is not only the parties; it is the media, the NGO’s, the doctors and patients who have an opinion on the topic. Their opinions are biased, and that doesn’t help the discussion. We will never reach an agreement if our judgment is clouded.

    • Wilson G says:

      I agree the discussion regarding this topic is extremely biased. It is hard to reform the healthcare system in any country, but when is divided as the U.S. is it is almost impossible. Everyone is pushing their own agenda forward, and they are forgetting about the important component, the consumer.

  3. Valerie D. says:

    The law is so flawed that those who need the coverage the most (chronically ill) are the ones with the burden. They are the ones who are left worse off with the reform. How can we claim that this reform is beneficial, if it is harming those who should be benefited?

  4. Jordan F says:

    I think that insurance plans that cover a percentage of the cost, rather than an amount, are beating the purpose. The goal of having insurance is to be able to predict what are going to be the cost if you get sick. For example having a co-pay of $2000 means that if everything goes wrong all you pay is that $2000. But if it is a percentage, it doesn’t give you that price ceiling. The costs that you will have to pay depend on how sick you are and which medicine you need. It is filled with variables and is hard to be prepared for them. Having these copayments based on a percentage benefits the insurance companies, not the consumers.

  5. Blake R says:

    I believe that the Reuters article is biased. It is highlighting the benefits while undermining the negatives. How can the American population take a stance if every source of information is intended to serve a biased agenda? If information were presented objectively, perhaps there would be a comprehensive reform that would benefit us all.

  6. Trent says:

    “In the past, we’ve seen 10 or 20 percent coinsurance rates. Now we’re seeing 30, 40 and 50 percent. So patients are being asked to bear more of the cost,”

    This has been the ObamaCare belief since the beginning though

  7. Yancey Ward says:

    There is nothing really surprising in this, is there? The fatal problem is the hope of Obama and his acolytes that certain classes of customers were willing to voluntarily over-pay for insurance. Insurance companies already knew this was a false hope, and constructed the policies appropriately to evade the stupid regulations.

  8. Bubba says:

    If the United States is to ever get a handle on medical spending, it will have to deal with the big ticket items like hospitalization and chronic illness. People spending $10,000 per year are probably wasting money on needless treatments. I don’t necessarily think the healthy should bear the wasteful spending of those who have chronic diseases that were largely brought on by lifestyle choices.

  9. Dupree says:

    I wonder what a pure catastrophic medical plan with a deductible AND out-of-pocket maximum of $6350/$12700 would cost? That is essentially what you have anyways if you are on a $2000 specialty drug covered at 50% that there is no alternative for. We’ll never know as this would be below bronze level.

  10. Bob Hertz says:

    Virtually everyone in America takes for granted that specialty drugs should cost so much in the first place.

    This would be very baffling to Canadians, Germans, French, Swedes, et al, where there are Pharmacy Price Review Boards that limit drug prices.

    The companies still come over and sell the drugs, too, they just make less money.

  11. John Fembup says:

    “they just make less money”

    Bob how do you know that? I think you’re guessing.

  12. Bob Hertz says:

    Note to John:

    among many articles, see “Europeans strike harder line on drug prices,”
    Financial Times, June 1, 2010


    • John Fembup says:

      Bob, you were guessing about margins before.

      And you justify your earlier guessing by citing prices?

      Lower prices do not necessarily mean lower margins.

      I still think you’re guessing. Sorry.