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Consumers may have to dig a little deeper into their wallets to pay for health care in the Obamacare insurance exchanges, according to a new analysis by Avalere Health.

The study of six states suggests that consumers could face steep cost-sharing requirements — like co-payments, co-insurance and deductibles — layered on top of their monthly premiums.

The health law sets exchange enrollees’ maximum annual out-of-pocket costs at $6,350. But many people won’t get near that limit, and deductibles for typical exchange plans can run twice as high as the average employer-sponsored plan.

It’s a reminder that despite news trumpeted Wednesday by the White House, suggesting exchange premiums will be lower than expected, consumers will have additional numbers to crunch.

Those buying coverage on the exchanges will have a choice of three levels — bronze, silver and gold — each offering increasingly generous benefits at correspondingly higher premiums. Enrollees who earn less than 400 percent of the federal poverty level will have access to tax credits to help offset their premium cost. There are also some cost-sharing subsidies available on a sliding scale for people earning less than 250 percent of the poverty level.

But the report estimates that a silver plan would have a deductible ranging from $1,500 to $5,000, which is higher than the average deductible ($1,135) for an employer-sponsored plan.

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“Consumers will need to balance lower monthly premiums against the potential for unpredictable, expensive, out-of-pocket costs in plans with higher deductibles,” Caroline Pearson, vice president of Avalere Health, said in a statement. “Furthermore, there is a risk that patients could forgo needed care when faced with high upfront deductibles.”

Avalere is a private consulting firm that advises clients on how health policy will affect them. Its study looked at plan information from Colorado, Connecticut, Indiana, Rhode Island, Vermont and Washington to draw its conclusions, although it’s unclear whether the results are applicable nationwide. All of the states in the study except Indiana are running their own exchanges rather than deferring to the federal government.

The study also suggests exchange enrollees could see higher drug co-pays and co-insurance than those in employer-sponsored plans.

Posted 4:19 PM  View Comments

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