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The basics

If you don't yet have health insurance, the next open enrollment period starts November 15, 2014. You'll want to comparison shop for your health insurance coverage, which is divided into four tiers: platinum, gold, silver and bronze. The lower-level tiers, including silver and bronze coverage, have lower premiums, but they also have higher out-of-pocket costs for consumers.

For information on enrollment, go to www.healthcare.gov

Patients with significant medical needs should be aware of the out-of-pocket costs associated with bronze and silver plans

The ACA is structured in such a way that bronze and silver plans feature lower premiums but higher patient out-of-pocket costs.  Patients should be sure and look at all of the out-of-pocket costs associated with these plans at the lower metal tiers.  They will likely include high deductibles, sometimes as much as $5,000 or $6,000 at the bronze level.  Carriers differ regarding whether or not pharmaceutical products are subject to the deductible, which is another key feature to ask about. 

If you rely heavily on products that are a part of the pharmacy benefit, also look for whether these plans have coinsurance, which requires you to pay a percentage of the cost of the drug or service, which can add up to hundreds or thousands of dollars per month.  As a cancer patient, or any patient with high cost medical needs this quickly becomes unaffordable. 

Below is a look at a handful of states and how plans in those states will price specialty drugs for patients in a bronze plan as well as in a silver plan.

The chart highlights the risks associated with bronze coverage: In every state here except New York, high patient co-insurances are prevalent in bronze coverage.

There is a maximum annual out-of-pocket cap which applies to the new marketplaces. In 2014, this maximum out of pocket is $6,350. While this does offer some basic protections against catastrophic debt, it also is limited to in-network services as well as pharmacy products that are on formulary, making it even more important that you know exactly what is covered by your plan.

last updated on Tuesday, August 19, 2014
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