News Alerts Enrollment: It Can Be A Simple Choice

Although it seems as if many insurers are leaving the health insurance exchange marketplace and premiums are likely to rise for many in 2017, there is some brightness set for Obamacare. There will be a new, attractive option available to many consumers beginning in November. In an attempt to make plan selection easier, the federal government is encouraging insurers to offer “simple choice” plans. What’s simple and appealing about these plans is that they are standardized and cover basic services without a deductible.


These new standardized plans will hopefully help eliminate much of the confusion that consumers experience when trying to make comparisons among the various plans offered on the marketplace. The government is providing guidelines to insurers for simple plans at each of the bronze, silver and gold levels, in addition to three more silver plan options for people who qualify for cost-sharing reductions based on income.

The beauty of these simple plans is that the deductibles and annual limits on out-of-pocket spending will be consistent among the plans, as will many of the consumer payments for services. For many specific services, participants will have flat dollar copayments up front for services, rather than having to meet a deductible before the plan will contribute to the cost. Under the standardized simple silver plan, copayments would be $30 for a visit to a primary care doctor, $65 for a visit to a specialist, $15 for a generic drug, $50 for a preferred brand-name drug and $100 for a nonpreferred brand name drug. Consumers may be responsible for up to 40 percent of the cost of specialty drugs, including certain high cost medications for cancer, rheumatoid arthritis and multiple sclerosis.

Insurers generally dislike standardized plans and are not required to offer these plans on the federal exchange. Standardized plans already exist in some of the state run exchanges, however the insurers aren’t obligated to offer them there either. Many insurers believe that these plans can complicate comparisons and that without some differentiation, it may be no easier for individuals to select from among yet another plan choice. These simple plans may also harm those individuals with conditions for whom standardized plans would not be the best alternative.

Open enrollment is upon us. If you’re purchasing health insurance from the federal marketplace, look for the simple plans in your state. It may make sense for you and your family.