HealthPocket Study: Obamacare Premiums Higher in Counties Without Preferred Provider Organizations

Exclusive provider organizations 15% more expensive in counties with no preferred provider organizations

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May 14, 2015, 12:00 ET

MOUNTAIN VIEW, Calif., May 14, 2015 /PRNewswire-USNewswire/ -- Obamacare health plans are required to meet the standards mandated in the Affordable Care Act, but plans may choose whether to cover out-of-network providers and whether to require referrals for specialist visits. Preferred provider organizations (PPOs) cover out-of-network providers and do not require referrals in most cases. Exclusive provider organizations (EPOs) and health maintenance organizations (HMOs) do not have out-of-network coverage, while point of service (POS) plans and HMO plans require referrals. Since PPO plans are generally the most flexible among the four plan types, HealthPocket analyzed monthly premiums on the 2015 federal health insurance marketplace to determine whether they were lower in counties where PPO plans were available.

HealthPocket found that in counties with no PPO plans, the average Obamacare premium for a 40-year-old individual was $327.28. The average Obamacare premium in counties with PPO plans was slightly lower at $325.43, despite PPO plans having an average premium of $339.68 and accounting for almost half of all plan options on the federal marketplace. Monthly premiums for HMO, EPO, and POS plans were 5% higher in counties with no PPO plans than in counties with PPO plans.

Premiums for POS plans were 6% higher in counties with no PPO plans than in counties with PPO plans, while HMO premiums were only 2% higher. EPO plans had the greatest premium cost difference, with average premiums of $335.55 in counties where PPO plans were available and $387.21 in counties where PPO plans were unavailable, an increase of more than 15%.

HealthPocket also found premium differences between counties with only one available plan type and counties with multiple available plan types. Plans in counties with only one available plan type had an average premium of $350.61, 8% higher than the average premium of $324.06 for plans in counties with multiple available plan types.

Among the four plan types, PPO and POS plans may appeal most to consumers that want to continue seeing their current doctors if other plans do not cover their current doctors in-network. However, cheaper HMO plans could be preferable for consumers that do not mind staying in-network and getting referrals from their primary care doctor. The results of this analysis show that consumers benefit when PPO plans are available to them, even if they choose not to buy PPO plans, since the other available plans have lower premiums.

The full report and methodology is available at "Obamacare Premiums Higher in Counties Without Preferred Provider Organizations".

HealthPocket.com is a free website that compares and ranks all health insurance plans, helping individuals, families, and small businesses to make their best health plan decisions. HealthPocket publishes health insurance market analyses and other consumer advocacy research. HealthPocket's research is nonpartisan and 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. HealthPocket, Inc. is independently managed and based in Mountain View, California. Learn more at www.HealthPocket.com.

For more information, please contact Ryan Hughes, Shirley & Banister Public Affairs at [email protected] or 703-739-5920/800-536-5920.

SOURCE HealthPocket