Public Square Plans; Crocker Park Development; ACA

Understanding Health Insurance and Drug Costs

Understanding Health Insurance

Putting Patients First
This site is provided by the National Health Council in partnership with Avalere Health to be a general resource for consumers seeking to understand health care reform and their insurance options. The site includes general information about the Marketplace, how to get help paying for insurance coverage and managing costs, general information about health insurance, resources for condition-specific patients, and guidelines to picking a health insurance plan.

How Health Insurance Works (PDF)
This American Cancer Society fact sheet details common concerns regarding health insurance and the effects of the new Affordable Care Act on it. It also features a breakdown of different healthcare costs and how to pick the best plan – including a user-friendly checklist on what to look for.

FAQs about Health Insurance
This American Health Association developed this list of frequently asked questions about the topic of health insurance and new changes because of reform. Primarily the site address finding the plan right for you and other important topics such as filing complaints about your insurance and what to do if you’re denied coverage for a service.

Understanding Drug Costs

Consumers Face More Hurdles to Accessing Drugs in Exchange Plans Compared to Employer Coverage
This analysis by Avalere Health explains findings that consumers on marketplace plans on average have a harder time getting prescription drugs compared to those covered by employer-base plans due to more common use of requirements to demonstrate appropriate use of the drug. The study encourages consumers shopping on the exchanges to look beyond premium costs when picking a plan.

Consumers Likely Face High Out-Of-Pocket Costs for Specialty Drugs In Exchange Plans
This Avalere Health analysis found that consumers in most exchange plans will have to pay a high amount for specialty drugs out of pocket. The analysis details how most exchange plans include co-insurance for specialty drugs, paying a high percentage of the drug cost rather than a set co-pay and warns consumers that high co-insurance can mean patients may incur several thousand dollars of cost-sharing drugs before reaching the out-of-pocket maximum.

Analysis: Exchange Formulary Structure More Similar To Part D Than Employer Coverage
Avalere Health analyzes in this report a study that found that the plans offered by issuers on the exchange on a whole resemble the structure of Medicare Part D as opposed to Employer-covered plans, most notably in the number of drug cost covering tiers. Higher-tiered drugs often required more co-insurance and other cost-sharing measures and so the study cautions consumers about these possible high out-of-pocket costs.

Analysis: Consumer Deductibles Vary Significantly Across Exchange Plans
This analysis by Avalere Health discovered many exchange plan deductibles vary drastically based on the metallic level relative to the changes in premiums. Although certain important preventative treatments and services such as flu shots have first dollar coverage, the study advises consumers to look at the whole package not just the premiums and to consider that another plan may be better when other aspects are included.

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