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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.
Specialty Drug Coverage in 2018 Medicare Drug Plans06-20-18
One of the major cost contributors to current levels of drug spending is specialty drugs, medications whose commonality is typically a very high retail price. To determine the extent of specialty drug coverage for Medicare beneficiaries, HealthPocket examined 2018 Medicare Advantage and Part D insurance plans from across the nation.
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2018 Affordable Care Act Premiums & Deductibles10-27-17
2018 is a pivotal year for Obamacare rates & deductibles as health plans faces new market realities and political pressures. HealthPocket's analysis explores the spikes in average premiums and deductibles for the Obamacare plans in 2018.
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2018 Brings Good News for Medicare Enrollees10-04-17
Average premiums for 2018 Medicare Advantage and Part D are going down on the national level as compared to last year. HealthPocket provides both national and state averages for premiums & deductibles.
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Specialty Drug Out-of-Pocket Costs Remain A Problem For the Affordable Care Act09-05-17
Specialty drugs continue to attract attention from health care analysts and politicians alike given their staggering costs to consumers and insurers.
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2017 Affordable Care Act Premiums & Deductibles10-26-16
Against the backdrop of big regional rate increases & insurance company departures, HealthPocket investigated the nationwide deductible and premium averages for Obamacare plans in 2017.
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2017 Medicare Part D & Medicare Advantage Premiums and Deductibles09-27-16
Premium and deductible trends for Medicare Advantage and Part D are quite positive for 2017 on the national level but a state-by-state analysis reveals significant disparities in average costs.
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Consumer Harm Hidden in Proposed Short-Term Health Insurance Rule07-31-16
In response to a government-proposed restriction on short-term health coverage, HealthPocket documents the unintended yet substantial consumer harm that will result if the new restriction is implemented unmodified.
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Unsubsidized Health Insurance Market & 2017 Rates03-17-16
The market for unsubsidized health insurance bears the brunt of the financial hardship if 2017 brings big rate hikes. But how large is this market and who is in it?
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Out-of-Pocket Charges for Specialty Drugs Increase as Retail Prices Surge12-08-15
HealthPocket compared 2016 ACA out-of-pocket costs for drugs to the out-of-pocket costs in 2014 ACA plans
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2016 Sees Large Decline in Out-of-Network Coverage Among Obamacare Plans11-18-15
When assessing options across the Affordable Care Act market, rate increases on existing plans as well in changes in the number of plans has resulted in double-digit increases in the average cost of premiums
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2016 Affordable Care Act Premiums & Deductibles11-02-15
When assessing options across the Affordable Care Act market, rate increases on existing plans as well in changes in the number of plans has resulted in double-digit increases in the average cost of premiums
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Almost Half of Obamacare Plans on Federal Marketplace Lack Out-Of-Network Coverage10-07-15
HealthPocket examined government data on Obamacare individual & family plans in the 37 states that use Healthcare.gov to determine the percentage of marketplace plans that offered out-of-network coverage.
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More $0 Premiums for Medicare Advantage in 201609-22-2015
HealthPocket analyzed 2016 Medicare plan data to determine how costs compared to 2015 Medicare plans.
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Do Provider-Owned Health Plans Produce the Cheapest Insurance Premiums?08-20-2015
Given their elimination of the fee-for-service model and its potential conflict of interests, HealthPocket examined whether provider-owned health plans produced less expensive health insurance premiums.
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Nonprofit Obamacare Insurers Have Lower Premiums than For-Profit Insurers in Most Counties that Use Healthcare.gov07-14-15
HealthPocket compared Obamacare premiums from nonprofit and for-profit insurers to determine whether nonprofit or for-profit insurers offered the lowest premiums in counties that used healthcare.gov.
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113 Fewer Counties Have Zero Premium Medicare Advantage Plans in 201506-25-15
HealthPocket examined Medicare Advantage plan data from 2014 and 2015 to determine which counties lost or gained $0 premium Medicare Advantage plans in 2015.
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Obamacare insurers propose 12% higher premiums for 201606-11-15
HealthPocket examined premium costs in public rate filings for 2016 Obamacare plans in 45 states.
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Obamacare plan selections on HealthCare.gov up this year in nearly all zip codes05-28-15
HealthPocket examined plan selection data for zip codes on healthcare.gov to determine which locations had the greatest changes in the number of plan selections from 2014 to 2015.
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Exchange-Only More Expensive Than Competitors Selling On & Off-Exchange05-21-15
When comparing the average premiums of exchange-only health plans versus health plans sold both on and off-exchange, HealthPocket found that the exchange-only health plans were not as competitive on price.
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Obamacare Premiums Higher in Counties Without Preferred Provider Organizations05-14-15
HealthPocket analyzed monthly premiums on the 2015 federal health insurance marketplace in counties without preferred provider organizations.
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Blue Cross Blue Shield Medicare Quality04-09-15
HealthPocket compared government quality ratings for Blue Cross Blue Shield Medicare plans.
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Medicare Advantage in Poorest Counties03-19-15
HealthPocket examined Medicare Advantage plans in the 25 counties with the lowest per capita income and compared them to national Medicare Advantage trends regarding premiums, deductibles, and access to $0 premium plans.
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Medicaid Acceptance by Healthcare Providers Falls in 201502-26-2015
As many primary care physicians receive lower government payments for Medicaid patients in 2015, HealthPocket examined how widely healthcare providers in general accept Medicaid in 2015.
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2015 Obamacare Deductible & Out-of-Pocket Averages11-20-14
HealthPocket analyzed gov data on 2015 Obamacare plans to determine the average deductible and out-of-pocket costs by plan type
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Early 2015 Obamacare Premium Trends11-18-14
The government released its ‘landscape’ data on 2015 Affordable Care Act health plans offered through 38 state exchanges & HealthPocket examined their average premiums by metal plan.
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Medicare Part D: Premium Vs. Deductible11-14-14
HealthPocket looked at 2015 Medicare Part D plans to explore whether higher premiums deliver better plan value.
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Average Premiums Rise Under Obamacare10-29-14
HealthPocket examined the average health insurance premiums of the first year of Obamacare and compared them to the averages found in the pre-reform market it replaced.
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2015 Medicare Drug Coverage and Drug Restrictions10-13-14
HealthPocket analyzed 2015 Medicare drug plans and found that the average number of covered drugs has decreased as compared to 2014 and the incidence of restrictions placed on covered drugs has increased.
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2014 Dental Plan Costs09-16-14
HealthPocket compared costs for 2014 dental insurance plans on the federal exchange.
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2015 Obamacare Specialty Drug Costs08-26-14
HealthPocket compared the costs for specialty drugs in 2015 Obamacare plans.
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Medicare Advantage Customer Service Ranking08-07-14
HealthPocket ranked the customer service of Medicare Advantage plans across the nation & also examined which states received the best and worst service.
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2015 Obamacare Out-of-Pocket Costs Preview07-14-14
Available data from 2015 rate filings reveal the changes in out-of-pocket costs are not following a consistent trend among the different metal plans. Learn more...
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Medicaid / Obamacare Gap06-18-14
HealthPocket examined premium affordability for 4.8 million Americans who earn too much to qualify for Medicaid but earn too little to qualify for a premium subsidy under Obamacare.
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Off-Exchange Vs On-Exchange06-05-14
HealthPocket compared the lowest premiums of 4 major off-exchange companies vs. the lowest premiums available on exchanges
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Costs Vary Widely Among Medicare Part D Plans05-21-2014
HealthPocket estimated costs of Medicare Part D plans for the top 50 drugs by units sold and found the lowest and highest cost Part D plans in each state and DC. On average the highest cost Part D plan in each state had 109% greater combined costs than the lowest cost Part D plan in the same state.
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Exchange Comparison: Brokers Vs. Government05-07-14
HealthPocket compared the number of plans offered, premiums, and deductibles among government and broker health insurance exchanges. See the results...
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97% of Medicare Advantage Plans Provide Additional Benefits04-16-14
HealthPocket compared the prevalence of additional vision, hearing, and dental benefits in 2013 and 2014 Medicare Advantage plans.
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Medicare Advantage Often Cheapest Option for New Medicare Enrollees03-26-14
When combining all money spent on insurance premiums as well as out-of-pocket costs, Medicare Advantage was 19% less than Original Medicare with a prescription drug plan and 45%
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8 City Study Finds Obamacare Subsidy Gap for Young Adults03-12-14
HealthPocket analyzed subsidy eligibility for 18-34 year olds across 8 cities and found a subsidy gap where income eligibility for subsidies was 41% narrower than the maximum allowed by law.
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Top 10 Medical Services Excluded Under Obamacare02-26-14
HealthPocket examined what medical services were most commonly excluded from health plan coverage in 2014 and compared these results to the most frequent exclusions within the pre-reform health insurance market.
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Drug Copayments & Co-insurance Rise Under Obamacare02-13-14
Prescription drug coverage is now included with all new health plans in the individual & small group markets under the Affordable Care Act. However, in a study conducted by Healthpocket, metal plans averaged a 34% increase in copayments and co-insurance fees compared to the pre-reform market.
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Higher Healthcare Costs Risked Using Shortcuts in Insurance Shopping01-22-14
National averages on deductibles and out-of-pocket caps can be misleading if used for local health insurance plan shopping. Consumers are advised to examine their local health plan options carefully, judging cost-sharing individually rather than based on a plan’s particular metal tier category. Failure to follow this advice could result in some unpleasant surprises with respect to deductibles and out-of-pocket expense limits.
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1-in-3 Obamacare Small Biz Health Plans Exceed Deductible Cap01-08-14
The Affordable Care Act contains a provision that caps the deductibles on small group health plans. For individual enrollees, the maximum deductible was limited to $2,000 while for families the maximum was $4,000. HealthPocket examined out many plans, if any, exceeded these limits.
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Cheapest Obamacare Plan Depends on Age & Healthcare Use12-19-2013
Using metal plan premium averages, HealthPocket examined how different healthcare usage scenarios changed which metal plan produced the lowest annual healthcare costs for various age groups.
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5 Myths About Short-Term Health Insurance12-17-2013
Short-term health insurance is a health insurance product considerably different than the new health plans created under the Affordable Care Act. This article corrects five common misunderstandings about the insurance and the medical coverage it provides.
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Average Deductible & Other Out-of-Pocket Costs for Obamacare Plans12-12-2013
HealthPocket analyzed Affordable Care Act (ACA) health plan data from 34 states and found significant differences in out-of-pocket costs among the new ACA ‘metal plans.’
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Medicare Part D & Top 10 Drugs: Wide Coverage With Some Sky High Costs12-05-2013
HealthPocket found that most Medicare drug plan formularies covered the top 10 drugs but many of these drugs came with high out-of-pocket costs.
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Assessing the Value of Highly Rated Medicare Advantage Plans11-22-2013
HealthPocket looked at premiums and out-of-pocket limits for highly rated Medicare Advantage plans and compared them to all plans. Our findings can help consumers identify how cost and quality interact.
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Fewer Medicare Advantage choices if you live in a rural area11-14-2013
HealthPocket compared 2014 Medicare Advantage plan data between rural and non-rural residents and found a more challenging situation in rural areas.
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Assessing 2014 Medicare Drug Plan Coverage Rules11-01-2013
In addition to premium costs, consumers should make sure drugs they take are on a plan's approved list. HealthPocket studied those lists for 2014.
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2014 Medicare Advantage Stars Shoot Upward10-24-2013
HealthPocket analyzed the quality focused star ratings for 2014 Medicare Advantage plans and found improvement over 2013.
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Assessing the 2013 Plan Renewal Option10-18-2013
Some individual health plan consumers may be able to renew their policies for 2014. HealthPocket evaluates that strategy.
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Comparison of State Health Insurance Exchanges10-17-2013
HealthPocket compared the health insurance exchanges for all 50 states as well as Washington D.C. Learn which state exchanges ranked high and low.
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2014 Medicare Prescription Drug Premiums Bring Good News10-10-2013
Medicare drug benefit premiums are stable on average, but shifts are occurring among carriers.
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2014 Medicare Advantage Maximum Costs Evaluated10-03-2013
Medicare Advantage plan information for 2014 gives consumers a good idea for how to budget for high medical cost situations.
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Health Insurance Exchange Plan Choices09-27-2013
On September 25, 2013 HHS released a report that included an outline of health plan options on exchanges. HealthPocket investigated how the number of plan options compared to the current market.
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Many 2014 Zero Premium Medicare Advantage Plans Available During Annual Enrollment09-26-2013
Zero premium Medicare Advantage plans are a popular consumer choice. HealthPocket's review of new information for 2014 plans shows one-third of the offerings will be zero premium plans.
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Off-Exchange Health Plans & Premium Competition09-05-2013
HealthPocket examined 1,621 health plans across 10 states where insurers have publicly announced they would not participate in the state’s health insurance exchange. The study found that in 9 out of 10 states examined the insurers intending to sell off-exchange currently average lower premiums than the other plans in their state.
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Age Factors Into ACA Buying Pattern08-27-2013
New consumer research shows that people not yet eligible for Medicare may be more reluctant to buy Obamacare plans than younger people. The effects of age based pricing and a subsidy cliff that comes into play help explain this situation.
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Coverage Rules for Medicare Drug Plans Impact Consumers08-07-2013
90 percent of Medicare enrollees have some sort of Medicare prescription drug plan, but HealthPocket research shows those plans can vary in how many drugs are on their coverage lists and for those they cover, how many are subject to the plans' advance approval and other restrictions. The research provides important guidance for consumers who need to select a plan to meet their needs.
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Top 10 Medical Services Excluded from Health Insurance07-31-2013
Coverage of medical services is not standardized and a variety of important services, ranging in expense and medical necessity, are not included within the benefits of many health insurance plans. HealthPocket examined the benefits of over 11,000 health plans to determine which medical services and procedures were most likely to be excluded.
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Medicare Advantage Quality and a Well-Known Brand07-16-2013
Does a well known brand indicate health plan quality? HealthPocket analyzed two Medicare Advantage health plan quality indicators: star ratings and member opinion surveys and found that AARP plans fall short of the level of top performing plans.
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Out-of-Pocket Drug Costs to Increase Under Obamacare07-11-2013
The Affordable Care Act mandates that new health plans provide drug coverage as an Essential Health Benefit. However, the issues of which drugs are covered and at what cost is more vague. With roughly 70% of the population using prescription drugs during a typical year, the issue of how the Affordable Care Act will affect drug coverage is an urgent one.
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Health plan quitters inform us06-25-2013
HealthPocket looked at numbers of people quitting and complaining about Medicare Advantage plans and how those numbers help consumers figure out plan quality.
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Welcome to the Bronze Age06-18-2013
While most states have not yet published insurers’ rate filings for the upcoming Affordable Care Act health plans, some fascinating trends can be seen within those filings that have been made public. What has emerged to date for Bronze Plans is an across-the-board increase in out-of-pocket costs for doctor visit costs, deductibles, and coinsurance charges used for more extensive medical services.
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Health Plan Consumer Exchanges: Private and Public06-03-2013
A HealthPocket comparison of health plans available through government websites and private exchanges shows gaps. Learn more about the review and the implications for its findings.
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Are Profits Making Health Insurance Unaffordable?05-22-2013
Is profit an impediment to affordable healthcare? HealthPocket compared health insurance premiums for nonprofit and for-profit health plans in 6 major cities across the United States to determine what, if any, differences existed between nonprofit and for-profit health plan costs.
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Medicaid Acceptance by Healthcare Providers05-01-2013
Not all doctors accept Medicaid and the quantity of doctors rejecting Medicaid insurance presents a potential challenge to the Affordable Care Act’s expansion of the program. Given the national rate of Medicaid acceptance, HealthPocket reviewed Medicaid acceptance rates in cities of contrasting economic status to determine if an area’s average household income had a bearing on Medicaid acceptance.
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Worries Over Obamacare Age Rating Are Supported for Younger Enrollees04-11-2013
Some industry analysts have predicted that the Affordable Care Act’s limitations on age-based premium increases would drive up health insurance premiums on younger enrollees. To determine the credibility of that prediction, HealthPocket examined over 20,000 premium quotes within the individual & family insurance market for men and women ages 23, 30, and 63.
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Health Plan Coinsurance03-25-2013
As a percentage of medical costs paid out-of-pocket by consumers, coinsurance is often used by a health plan as a method of cost-sharing for more expensive services such as hospitalization, surgeries, child birth, and emergency care. HealthPocket analyzed 9,711 plans that used coinsurance rates to determine the average coinsurance charge across the nation.
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Essential Benefit Coverage03-07-2013
Given that health insurance plans will have to meet new minimum coverage standards starting in 2014, HealthPocket examined the current marketplace of individual health plans to measure the market disruption that will occur as these plans are replaced by plans compliant with the ACA's Essential Health Benefit standards.
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Health Insurance Premium Increases02-19-2013
Monthly premiums are a key factor affecting individuals’ choice of health insurance or whether to insure at all. When a consumer applies for coverage the insurer may decide to offer a more expensive premium than the premium quoted. HealthPocket analyzed 10,817 health plans to determine how widespread this practice is.
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Health Insurance Out-of-Pocket Costs02-07-2013
A comparison of the ACA’s cap on annual out-of-pocket costs against those of existing health plans provides a broader assessment of the Affordable Care Act’s financial consequences for consumers than studies that examine premiums alone.
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Health Insurance Declination Rates01-24-2013
Health insurance declination rates, i.e. the percentage of applications rejected by insurers, remain a serious issue for U.S. consumers until 2014 when guaranteed issue protections are fully enacted.
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