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Copayments and coinsurance fees rise for drugs due to ACA

Posted On Thu, February 13, 2014

The Affordable Care Act has run into its fair share of problems, the latest of which is that copayments and coinsurance fees have drastically risen as a result of the implementation of the law. 

According to data from, copayments and coinsurance fees increased 34 percent when compared to the days before the new health care legislation. Additionally, the study showed that price rose for all the four new health plan categories under the Affordable Care Act,  with the Bronze health insurance plan seeing copayment and coinsurance increases of 58 percent, marking the highest of any plan. Platinum had the lowest, with costs rising 15 percent. 

HealthPocket noted that drug spending is influenced by a number of things, so a 34 percent increase in copayments and coinsurance doesn't mean consumers will spend 34 percent more for drugs. Costs are also influenced by deductible amounts, out-of-pocket caps and what drugs are included. While only 1 in 5 consumers were covered for prescription drugs prior to the Affordable Care Act, now every plan has a drug benefit. Experts note that consumers have to be wise when shopping. 

"With copayments and coinsurance fees rising, consumers must shop health plans more carefully," said Kev Coleman, head of research and data at HealthPocket. "Copayments, deductible amounts and limits on annual drug spending should not be ignored. Consumers can also discuss with their doctors whether there are alternative drugs that have lower costs but equivalent therapeutic results."

Enrollments hits nearly 3.3 million
The U.S. Department of Health and Human Services announced that nearly 3.3 individuals signed up for private health insurance plans through state and federal exchanges during the first four months of open enrollment. Still, the Obama administration is halfway to its goal of having 7 million enrollments by March 31. However, much of the new enrollments came during January. 

According to the data, there were 1.4 million individuals enrolled for state exchanges and 1.9 million individuals enrolled for federal exchanges during January. The report suggested that nearly 40 percent of all federal exchange enrollments occurred during January. 

HHS Secretary Kathleen Sebelius said it is very encouraging news. Of those who signed up in January, 27 percent were between the ages of 18 and 34, marking a 24 percent increase when compared to the first three months of open enrollment. 

"We're seeing a growing population of Americans who are young, healthy and well covered, and these younger Americans are signing up in greater proportions," Sebelius said.

Women seeking coverage more than men
While the increase in the amount of young people enrolling in January is positive sign, there is a gender discrepancy, as women are seeking coverage more than men. According to the HHS, 55 percent of those seeking coverage are women. In Oregon, women account for 60 percent of signups, while in Mississippi, they account for 62 percent. 

"We know that overwhelmingly in American households the women make many of the shopping choices, and absolutely the healthcare shopping choices," said Ceci Connolly, managing director of PWC's Health Research Institute. "They just have been playing that role in our society for a long time."

Choosing a plan
Finally, the HHS study offered some insight on what plans Americans are benefiting from the most. Of those enrolled in federal exchanges, 60 percent opted for silver plans, which are designed to cover 70 percent of medical costs.

Connolly notes that to qualify for subsidies, consumers must have a plan with coverage at or above the silver plan. She said that "in the vast majority of cases," choosing the silver plan is a better choice, and consumers are beginning to recognize that. 

Those looking for cheap insurance rates are encouraged to enlist reputable help. As the effects of the Affordable Care Act are slowly being seen, consumers should prepare. 

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