Deductible Cap Waiver Has Big Consequences for Small Business, Reports HealthPocket

Jan 08, 2014, 10:00 ET from HealthPocket

96% of Bronze Plans for Small Employers Exceed Deductible Limits

SUNNYVALE, Calif., Jan. 8, 2014 /PRNewswire-USNewswire/ -- The Affordable Care Act capped deductibles for small group health insurance plans at $2,000 for individuals and $4,000 for families. However, the Department of Health & Human Services announced in February 2013 that these deductible limits could be waived in situations where a limit prevented a health plan from meeting its ratio of insurance payments to enrollee out-of-pocket costs under the Affordable Care Act.

Using government data on this year's small group health plans from 32 states, HealthPocket analyzed the average out-of-pocket costs for the major health plan types and then determined what percentage of plans, if any, exceeded the original deductible limit for the small group market. For individual enrollees in small group health plans, HealthPocket found that 35% of the plans studied had deductibles that exceeded the Affordable Care Act Limits. When analyzed by plan type, HealthPocket found:

  • 96% of Bronze plans had deductibles over the $2,000 cap
  • 28% of Silver plans had deductibles over the $2,000 cap
  • 6% of Gold plans had deductibles over the $2,000 cap
  • 0% of Platinum plans had deductibles over the $2,000 cap

When examining deductibles for families, similar results were found with respect to the percentage of plans that exceeded the $4,000 family deductible cap.

Strictly enforcing the deductible caps for small group health plans could have substantially narrowed the inventory of health plans in the Small Business Health Options (SHOP) marketplace or inflated the out-of-pocket costs for doctor visits and other medical services.

"As the implementation of the Affordable Care Act gets progressively modified, we are finding a variety of downstream consequences for consumers," said Kev Coleman, Head of Research and Data at HealthPocket, "In the case of the small group market, the conditional waiver has allowed the deductible for bronze plans to average over twice the amount of the original deductible limit."

The full findings can be reviewed in the study "1-in-3 Obamacare Small Business Health Plans Exceed Deductible Cap." 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. Learn more at

Emily Cashel, (703) 739-5920 or (800) 536-5920,

SOURCE HealthPocket