The number of silver-level PPOs on the marketplace with no out-of-network financial cap in 2016 has doubled from 2015.
As insurers work to keep premium costs stable, out-of-network caps have quickly disappeared. For 2016, 45 percent of the silver-level PPO plans coming to market for the first time have no annual out-of-pocket cap, according to an analysis by the Robert Wood Johnson Foundation.
Silver-level plans—the second-lowest cost plans available—are the most commonly purchased in the marketplace. What we’re seeing is the average PPO offers less comprehensive coverage in 2016 than it did in 2015.
The financial exposure PPO members may face now is very real and amplifies the importance of making smart health care decisions to choose in-network care. Even if a procedure is performed by an in-network doctor at an in-network facility, there’s a chance other components of that procedure—a non-contracted physician or lab service—wouldn’t be covered by a PPO.
Keep an eye on these plan types moving forward. Members value the freedom of PPOs, but that flexibility and affordability is slowly being eroded to keep premium costs stable.