Many of today’s health plans violate PPACA

Posted on: Monday, February 11, 2013

Were the Patient Protection and Affordable Care Act to be enacted today, many insurance customers would be paying more for coverage than they are allowed.

Under current guidelines of the PPACA, policyholders can spend no more than $6,250 each year out-of-pocket for health insurance costs. But in 36 percent of cases, plans are in excess of this threshold, according to HealthPocket.

In addition, the guidelines of the PPACA require insurers to reveal the cost in deductibles of each health plan so customers can understand what their responsibility is. But in nearly 40 percent of cases, this type of transparency was not adhered to.

"While the average out-of-pocket costs limit nationwide falls within ACA guidelines, there are still thousands of plans that need to improve their out-of-pocket costs for 2014," said Kev Coleman, head of research and data at HealthPocket.

He added that certain states will yield more benefits from these requirements than others due to state laws that are already on the books. Those states include Vermont, Alabama and Florida.

HealthPocket notes that most health plans in effect today have limits on how much a consumer can pay in out-of-pocket spending. But among those health plans that don't, it could result in severe financial hardship for individuals who incur a serious disease or injury. Because diagnoses often require a surfeit of lab tests, extended hospital stays and even surgery for severe health maladies, it could ultimately cost policyholders $100,000 or more in out-of-pocket expenses.

The PPACA bill is more than 2,000 pages long and has an additional 13,000 pages of regulations. Because of its size, some are in favor of delaying the implementation of the PPACA so more insurers can abide by its precepts.

Posted In: Insurance News, Health Insurance

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