Out-of-Network Health Care Can Be Financially Devastating to Consumers
Uncovered Out-of-Network Care Can Cost Consumers Tens of Thousands of Dollars
MOUNTAIN VIEW, CA-- With open enrollment approaching, AgileHealthInsurance.com has released a new study illustrating how a lack of out-of-network coverage within Obamacare exchange plans can cost enrollees tens of thousands of dollars if they do not remain in-network for their medical care.
Out-of-network care has been a growing consumer concern due to two factors: the prevalence of narrow network health plans within Obamacare and frequent restrictions on out-of-network care. A 2015 study by Avalere found that Obamacare plans sold on exchanges had 34 percent fewer health care providers in-network than commercial health plans sold off-exchange. An analysis by the research division of HealthPocket found that almost half of Obamacare plans on HealthCare.gov do not cover costs when enrollees get out-of-network health care, unless there is an emergency or the plan gives prior authorization for the health care.
Provider network restrictions can be financially devastating for consumers because they could have to pay their whole medical bill out-of-pocket if they choose to see an out-of-network provider. Given the possibility of catastrophic out-of-network medical costs, it is important for consumers to choose a plan with either a broad provider network or out-of-network coverage in case they develop a medical condition where the best care would be outside a narrow network.
"If you wait until something catastrophic happens medically, it's already too late," said Sam Gibbs, executive director of AgileHealthInsurance.com. "In times of extreme medical need, you want to have all possible options available."
Term health insurance plans are a compelling alternative for dissatisfied Obamacare consumers. Term insurance plans have broader provider network coverage than most Obamacare plans so enrollees can go to most doctors and still be covered. Out-of-network coverage is available in 100 percent of the term insurance plans sold on AgileHealthInsurance.com.
In 2012, the average cost for a surgical hospital stay was $21,200, according to the Agency for Healthcare Research and Quality. When the surgery is out-of-network, enrollees pay the full amountif they have an Obamacare plan without out-of-network coverage. However, with a comparable term insurance plan, the enrollee would pay $7,500 less, according to the AgileHealthInsurance.com analysis.
Term health insurance represents a distinct category of health insurance and does not provide identical coverage as Obamacare plans, and benefit and eligibility differences contribute to the cost savings observed. Consumers apply and, depending on their health status (including pre-existing conditions), they may or may not be eligible for specific plans. Consumer applications are approved or rejected based on health status (including the nature of pre-existing conditions). Additionally, with term health insurance, consumers may still be subject to the Obamacare Tax unless they qualify for one of several exemptions from the tax. The cost of term health insurance is so affordable that even for some consumers facing the tax penalty, the combination of penalty and premium is still less expensive than an unsubsidized Obamacare premium.
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AgileHealthInsurance.com is a Silicon Valley-based technology company and independently managed division of Health Insurance Innovations, Inc. (NASDAQ: HIIQ). This press release contains "forward-looking statements" within the meaning of the U.S. Private Securities Litigation Reform Act of 1995. Forward-looking statements are statements other than historical fact, and may include statements relating to goals, plans and projections regarding new markets, products, services, growth strategies, anticipated trends in our business and anticipated changes and developments in the United States health insurance system and laws. Forward-looking statements are based on our current assumptions, expectations and beliefs are generally identifiable by use of words "may," "might," "will," "should," "expects," "plans," "anticipates," "believes," "estimates," "predicts," "potential" or "continue," or similar expressions and involve significant risks and uncertainties that could cause actual results, developments and business decisions to differ materially from those contemplated by these statements. These risks and uncertainties include, among other things, our ability to maintain relationships and develop new relationships with health insurance carriers and distributors, our ability to retain our members, the demand for our products, the amount of commissions paid to us or changes in health insurance plan pricing practices, our ability to integrate our acquisitions, competition, changes and developments in the United States health insurance system and laws, and our ability to adapt to them, the ability to maintain and enhance our name recognition, difficulties arising from acquisitions or other strategic transactions, and our ability to build the necessary infrastructure and processes to maintain effective controls over financial reporting. These and other risk factors that could cause actual results to differ materially from those expressed or implied in our forward-looking statements are discussed in HIIQ's most recent Annual Report on Form 10-K filed with the Securities and Exchange Commission (SEC) as well as other documents that may be filed by HIIQ from time to time with the Securities and Exchange Commission, which are available at www.sec.gov. Any forward-looking statement made by us in this press release is based only on information currently available to us and speaks only as of the date on which it is made. You should not rely on any forward-looking statement as representing our views in the future. We undertake no obligation to publicly update any forward-looking statement, whether written or oral, that may be made from time to time, whether as a result of new information, future developments or otherwise.