HealthPocket provides unbiased reports on the private health insurance market, analyzing data, identifying trends and gauging consumer sentiment.
Designed to educate and inform, the HealthPocket Research Center focuses on the state of the U.S. health insurance market, in particular, the individual and family and Medicare market. It presents facts, conducts polls, observes trends, and provides in-depth analysis. Additionally, HealthPocket leverages the government’s Open Data Initiative alongside other resources to provide non-partisan information. From side-by-side comparisons of health insurance plans to reports on emerging issues, HealthPocket provides the unbiased tools essential to understand, navigate, and reform the volatile health insurance market.
Founded in 2012 by Bruce Telkamp and Dr. Sheldon Wang, HealthPocket pioneered a model of consumer advocacy in health insurance that combined free access to government health plan data with nonpartisan research on market trends. By January 2013, HealthPocket published the first of its dozens of research reports and quickly established itself as a leading source of unbiased healthcare research.
HealthPocket’s research is typically categorized as either an InfoStat or an InfoPoll.
HealthPocket research has been cited in most of the leading news sources within the United States. Examples of these citations include:
HealthPocket’s nonpartisan research has been relied upon by both sides of the political aisle to inform policy positions and health insurance reform. From the Congressional Budget Office under President Obama to the Trump White House, HealthPocket’s data and reports have been relied upon to provide clear, unbiased data. Key contributions include:
Jesse Geneson is a Research & Data consultant and a contributor to HealthPocket's research publications. He lives in Cambridge, MA and holds a degree in Mathematics from Harvard University and is currently a doctoral candidate in Applied Mathematics at MIT. His mathematics research includes papers in combinatorics, graph theory and pattern avoidance.
Steve Zaleznick has several decades of experience developing and leading highly regarded programs for consumers of health care and financial services. Key areas of focus for Mr. Zaleznick include Medicare, health insurance decision support tools and health insurance exchanges. Mr. Zaleznick lives in Washington, DC and holds a degree in Economics from Brown University and a law degree from Georgetown University.
Jeff is a health insurance entrepreneur with 30 years of business and product development experience. He has been a keynote speaker at many trade conferences focusing on emerging health insurance trends, and has written extensively on how brokers and advisors should tailor benefit plans to meet individual client needs. Most recently he was chief marketing officer at The IHC Group ( NYSE:IHC) and president of American Independence Corp. (NASDAQ:AMIC). Earlier in his career he helped develop state-based risk pools for the medically uninsurable, and was the founder of the National Association of State Comprehensive Health Insurance Plans. He has testified on insurance related topics many times before state and federal legislative committees. He lives in Eden Prairie, MN.
Dave has over 25 years of experience in the health care management field. His experiences span the areas of Health Plan marketing and operations, medical group and hospital administration and public health policy development. In addition he has been an officer in several health care related start-ups. The most recent was Benu, Inc. a private, multi-carrier exchange company. A primary focus of his career has been product and business development in the managed care industry. He has developed and implemented innovative new products for a number of health plan industry leaders. His experience has also included serving as President /COO of a regional health plan and medical group operation. Dave received his undergraduate degree from Gustavus Adolphus College in St. Peter, Minnesota and his Masters in Hospital and Health Care Administration from the University of Minnesota.
Peter has over thirty years of experience in program management and the engineering of health, education, and geophysical information services. For several years he served as adjunct professor for the University of San Francisco, with focus areas in management information systems and customer-centric approaches to systems analysis and design. Peter lives in Northern California and holds degrees in physics from the State University of New York (SUNY) at Oneonta and the University of Vermont, where he specialized in stochastic modeling of neural networks.
The three key issues that drive HealthPocket’s Obamacare research are the three issues that most affect consumers: premiums/out-of-pocket costs, benefits, and provider availability. Leveraging publicly and privately available data, conducting polls, and analyzing trends, HealthPocket breaks down the facts and figures and gauges consumer sentiment.
Beginning with the launch of Obamacare in 2014, HealthPocket has analyzed ACA premiums and out-of-pocket costs including deductibles and co-pays. HealthPocket’s research has not only illuminated changes in premiums and expenses, but also which demographic groups are most affected by them.
|For 2017, aging consumers without subsidies will hit hardest by Obamacare spikes in premiums and deductibles. |
|The monthly out-of-pocket costs for the top five specialty drugs on a bronze 2017 plan ranged from $1,765 to $13,748. |
|In 2017, the average bronze plan premium nationally rose 21% with the deductible averaging $6,092 for an individual and $12,393 for a family. |
|2015 Bronze plans premiums reduced an average of 12%. |
|Copayments for low-cost generic drugs for Bronze plans experienced increases in copayments compared to 2014. |
|Average premium in 2014 for a 23-year-old woman was up about 44.9% from 2013, while men of the same age had a 78.2% increase. |
While premiums continue to rise, HealthPocket polls reflect that consumers are anxious about price and yet uncomfortable with proposed changes to Obamacare.
|Most consumers cannot afford to spend more than $100 per month on health insurance premiums. |
|36% of adults surveyed nationally would reject an Obamacare replacement even if it meant lower premiums. |
|Over half of Americans find the Medicaid Gap either confusing or unfair. |
To contain rising premiums, insurers have explored alternative models, which HealthPocket has studied.
|Eliminating fee-for-service models has not produced the cheapest health insurance plans. |
|Non-profit insurers are most likely to offer the least expensive premiums than their for-profit counterparts. |
|Health plans sold exclusively on health insurance exchanges had higher premiums than those sold both on and off the exchanges. |
Under the Affordable Care Act, a qualified health plan must include ten Essential Health Benefits (EHB). How those benefits are implemented vary according to each states’ guidelines. HealthPocket provides a primer on the ten EHBs. Through the HealthPocket engine, current and previous year health plans can be compared.
|Comparing 2016 ACA plans to those in 2014, some out-of-pocket costs charged for prescription drugs rose significantly, with one category seeing an increase of 71%. |
|While coverage for medical conditions such as infertility and obesity has increased, services excluded in the pre-reform market including weight-loss surgery continue to be excluded. |
|In 2013, before the launch of Obamacare, less than 2% of the existing health plans in the individual market provided all the Essential Health Benefits required under the ACA. In particular, pediatric and maternity services were often not included. |
While the ACA has extended coverage to millions of Americans, there has been an increase in the use of "narrow" provider networks, which decreases a consumer’s ability to access medical care from their preferred doctors and hospitals. Consumers in narrow networks may find their preferred physician or a needed specialist out-of-network, a situation that requires the consumer to bear a greater financial cost to see their preferred provider or to reassess their provider choices to stay in network.
|In 2016, 59% of 2016 ACA plans do not have out-of-network coverage, except when the enrollee has a medical emergency or obtains prior authorization from the plan before receiving out-of-network healthcare. In three states (New Jersey, New Mexico, and South Dakota), every 2016 ACA plan lacks out-of-network coverage. |
|Medicaid Acceptance by Healthcare Providers Drops to 1-out-of-3 in 2015. |
|Obamacare Premiums Higher in Counties Without Preferred Provider Organizations. |
|Of the 2015 ACA plans sold on Healthcare.gov, nearly 47.4% lacked standard out-of-network coverage. |
While Obamacare (i.e. Affordable Care Act health plans) are the dominant form of individually purchased health insurance in the U.S., today there are three other alternatives within the market. Below are some of the most common forms of non-Obamacare private health coverage products:
Medicare is an enormous health insurance program, covering tens of millions of Americans and spending billions of dollars annually. Two of Medicare’s most visible programs, Part D prescription drug coverage and Medicare Advantage health plans, have made enormous amounts of data available regarding their deductibles, premiums, and quality ratings. HealthPocket has leveraged this data to keep Medicare beneficiaries up to date on the trends as products change annually.
Since its inception in the 1960s, the Medicaid program has provided an important healthcare safety net for consumers of limited means. While enrollees who qualify for the Medicaid program do not pay for this insurance, there have been concerns about its acceptance among healthcare providers. Consequently, HealthPocket periodically examines Medicaid acceptance by healthcare providers in the U.S.
HealthPocket's InfoStat Reports provide analyses and interpretation of the healthcare market as well as emerging issues related to the implementation of the Affordable Care Act.See All InfoStat Articles »»
HealthPocket's InfoPolls are consumer surveys that focus on the key issues transforming America's health insurance market.See All InfoPoll Articles »»
HealthPocket offers journalists a free service supplying regional health insurance market data upon request.Learn More»»
HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.