Analysis Reveals Average Out-of-Pocket Cost for Obamacare Plans

Significant differences in out-of-pocket costs across new 'metal' plans

SUNNYVALE, Calif., Dec. 10, 2013 /PRNewswire-USNewswire/ -- 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.' Under the ACA, health plans are no longer differentiated primarily by the benefits they cover but, rather, the percentage of medical costs paid by the health plan for a typical enrollee population. The entry-level bronze plan covers 60% of enrollee costs, the silver plan 70%, the gold plan 80%, and the platinum plan 90%. However, when looking at the average deductible amounts for each of the metal plans, the differences were significantly larger than the 10% plan payment increments differentiating the plans.

HealthPocket found the average deductible amount for each of the four metal plans as follows:

  • Bronze Plan: $5,081 for an individual / $10,386 for a family
  • Silver Plan: $2,907 for an individual / $6,078 for a family
  • Gold Plan: $1,277 for an individual / $2,846 for a family
  • Platinum Plan: $347 for an individual / $698 for a family

The average doctor visit charge for a primary care physician and the fee for a specialist visit can be reviewed for each metal plan on the following pages: bronze plan, silver plan, gold plan, and platinum plan.

With respect to the annual caps on out-of-pocket costs for covered medical services delivered by in-network healthcare provides, the differences among the were less dramatic than was the case for deductibles but again did not have consistent progression from bronze to platinum plan that followed their respective actuarial values (i.e. the percentage of medical expenses the health plan is expected to cover).

  • Bronze Plan: $6,267 for an individual / $12,569 for a family
  • Silver Plan: $5,730 for an individual / $11,495 for a family
  • Gold Plan: $4,081 for an individual / $8,649 for a family
  • Platinum Plan: $1,855 for an individual / $3,710 for a family

"We observed that deductibles drop more dramatically among metal plans than their differing actuarial values would suggest," said Kev Coleman, Head of Research & Data at HealthPocket, "Consumers should be factoring in their expected healthcare usage alongside premiums when comparing the new Affordable Care Act health plans. However, for those people who have need of a specific doctor or hospital, it is important to note that the annual out-of-pocket expense protections only apply to covered medical services delivered by in-network healthcare providers."

HealthPocket will release the full Affordable Care Act out-of-pocket study later this week on is a free website that compares and ranks all health insurance plans available to an individual, family, or small business to allow consumers to make their best health plan decision and reduce their out of pocket costs. HealthPocket uses only objective data from government, non-profit, and private sources that carry no conditions that might restrict the site from serving as an unbiased resource. The founders of spent decades pioneering internet-based access to health insurance information and created HealthPocket to offer an online resource to positively change how people buy and use healthcare in the U.S. Learn more at

For further information, please contact Emily Cashel with Shirley & Banister Public Affairs at, (703) 739-5920 or (800) 536-5920.

SOURCE HealthPocket

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