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Life Health > Health Insurance

Feds designing PPACA plan hole analyzer

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The Patient Protection and Affordable Care Act (PPACA) was supposed to help consumers shop for health plans on an apples-to-apples basis.

Consumer groups have complained that’s not always happening, and that many consumers end up with much higher out-of-pocket costs than they expected.

Agents and brokers say the best way to make sure consumers understand their coverage is to encourage consumers to talk to licensed producers.

The Center for Consumer Information & Insurance Oversight (CCIIO), the arm of the U.S. Department of Health and Human Services (HHS) in charge of PPACA programs that affect the commercial health insurance market, is trying to automate the process of helping consumers understand plan benefits by adding an out-of-pocket cost comparison tool to

CCIIO officials want to offer the cost comparison tool for the 2016 open enrollment period, which is set to start Nov. 1 and end Jan. 31.

Officials want shoppers to be able to give their age group, level of health care service use, and some other information, and get estimates of how a particular plan might affect their out-of-pocket costs.

CCIIO is asking for comments on the data sources it might use to generate the estimates, use of health plan cost-sharing data, and the kinds of information the tool should ask for.

See also: Taking advantage of health care transparency trends

CCIIO is also asking whether it ought to make an open source version of the tool available for state-based exchange programs.

Comments on the proposal are due June 29.


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