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Consumers Beware: Not All Health Plans Cover A Doctor's Visit Before The Deductible Is Met

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In Philadelphia, by contrast, 33 percent of bronze plans require policyholders to pay the deductible first, the smallest percentage among the cities studied.  The average bronze deductible there was $5,689.

Among silver plans, the analysis showed that far more provide some coverage before the deductible is paid.  Of 14 plans examined in Chicago, for example, only one required the deductible to be fully met before the consumer could see a primary care doctor for a small copayment.  All but one insurer, Land of Lincoln Mutual, were included in that analysis.

 In Florida, 90 percent of silver plans offered in Tampa and 89 percent in Miami allowed coverage for at least some doctor visits before the deductible was met. In Florida, however, the database did not include one major insurer, Florida Blue, which has more than 18 plans in the Miami market alone.   Florida Blue did not respond to requests from KHN for information about which of its plans cover doctor visits before the deductible is met.

Don’t Assume Lowest Premium Plan Is Best

Cigna spokesman Joe Mondy said that the insurer sought to offer consumers a range of choices. Some of Cigna’s plans, for example, allow in-network visits with primary care doctors before the deductible is met, typically for a $30 to $45 copayment, while others do not.

"We structured the plans with the recognition that a lot of the new customers have never had a primary care or family doctor," Mondy said. Plans that allow primary care visits for a small copayment are expected to foster doctor-patient relationships, he said.

Under the law, there are special provisions for lower-income Americans who purchase a silver plan but not a bronze plan.  People who earn less than 250 percent of the poverty level -- about $28,700 for an individual -- get extra help from the federal government in the form of lower copayments for doctor visits and smaller annual deductibles.  For the lowest-income residents, that can mean plans with little or no deductible and copayments as small as $3 for primary care doctor visits.

Fri, Dec 20 2013

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