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HHS exchanges seem short on platinum

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Consumers and small employers who prefer plans with high premiums but low out-of-pocket costs might be out of luck next year.

Paul Houchens and other actuaries at Milliman report in an analysis of Patient Protection and Affordable Care Act exchange plan menus that rich, platinum-level products are scarce in the individual exchanges and the Small Business Health Options Program exchanges.

Typical individual HHS exchange users will see only one insurer offering platinum-level “qualified health plans,” and employers using SHOP exchanges will be lucky if they can get platinum coverage from even a single carrier.

Typical exchange shoppers could see three to four carriers offering bronze, silver and gold plans in the individual space, and about two carriers offering those levels of coverage in the SHOP market.

Silver plans are the most common, the actuaries found.

Insurers may have feared that platinum coverage buyers would have high levels of claims, the actuaries theorized.

The actuaries looked at the plan menus for the 34 states with individual exchanges run by HHS and the 32 states with HHS-run SHOP exchanges.

PPACA requires issuers of individual policies and small-group plans to put their new, 2014 products in “metal levels” based on the percentage of the actuarial value of a standardized “essential health benefits” package that the insurance covers.

Some young consumers can buy high-deductible catastrophic plans. For other consumers, the choices range from bronze QHPs, which cover about 60 percent of the actuarial value of the EHB package, to platinum plans, which cover about 90 percent of the actuarial value of the EHB package.

The creators of the exchange system hoped to increase the level of competition, but most of the participating carriers had large shares of their states’ markets in 2012, the actuaries said.

In the individual market, most of newcomers are Medicaid plans or the new nonprofit, member-owned CO-OPs, the actuaries said.

In the SHOP market, most of the new players are CO-OPs, the actuaries said.

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