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AARC to HHS: Provide an Out-of-Pocket Calculator

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October 16, 2013

Millions of Americans are already trying to purchase health insurance via the new health insurance marketplaces created by the Affordable Care Act. When they do, they are asked to choose between “bronze,” “silver,” “gold,” and “platinum” plans. The law required each of the marketplaces to develop an electronic calculator to help them make an informed decision, but specific requirements for an out-of-pocket cost estimator were not included.

The AARC has joined more than 85 other organizations in signing on to a letter asking HHS Secretary Kathleen Sebelius to incorporate an out-of-pocket cost estimator into the regulations so people seeking a qualified health plan (QHP) through the marketplaces can get a realistic idea of what their out-of-pocket costs will be under QHPs in each of the options.

The out-of-pocket calculator is considered especially important for those with chronic health conditions and/or disabilities, who are likely to make greater use of the health care system and thus will incur higher out-of-pocket costs.

“We strongly encourage CMS to recognize that the ‘actual cost of coverage’ has a broader meaning than premium and select cost-sharing structure alone,” says the letter. “For patients to adequately compare costs across available QHPs, they need access to a tool that assists in the calculation of expected out-of-pocket costs across an entire plan year.”

CMS has already developed such a tool for use by Medicare beneficiaries shopping for Medicare Advantage plans.