Author: Ideon

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

This is the second of three posts on this subject

As we discussed in our previous post, emergency room visits are not only one of the most common interactions people have with our healthcare system, but they can be quite expensive for both individuals and their insurance companies. In recent years, urgent care clinics have emerged as a cheaper alternative to the emergency room for less severe conditions like the flu and injuries that occur outside traditional providers’ business hours and for folks without a regular doctor. In our analysis, we showed that insurance companies are more likely to share costs before the deductible for urgent care than for the emergency room. In this post, we take a deeper look at the structure of that cost sharing.

The data science team at Vericred analyzed the benefit designs for silver plans on the individual market to investigate how cost sharing between individuals and their health insurance companies is structured for emergency rooms versus urgent care. The results show that the most common type of cost sharing for emergency room visits is a coinsurance that applies only after the deductible has been met (median: 25%). This means that an individual would pay the full cost until her deductible is met, then a set percentage of the emergency room charges above that. In contrast, the most common type of cost sharing for urgent care is a copay that applies regardless of the deductible (median: $75). This means that an individual would pay a flat dollar amount regardless of the charges for the urgent care visit and whether or not she has met her deductible.

In advance of finding yourself footing a costly bill, it’s worth checking your insurance coverage to see the difference in the way emergency room and urgent care visits are covered. You may end up significantly reducing your healthcare expenses should you experience an urgent medical condition when the option to see your doctor is not available.

This is the second of three posts; in the next post, we will investigate how the difference in emergency room cost sharing has changed over time.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

This is the first of three posts on this subject

Emergency room visits are one of the most common interactions people have with our healthcare system, and they can be quite expensive for both individuals and their insurance companies. In recent years, urgent care clinics have emerged as a cheaper alternative to the emergency room for less severe conditions like flu and minor injuries that occur outside traditional providers’ business hours and for folks without a regular doctor.

The data science team at Vericred analyzed the benefit designs for health insurance plans on the individual and small group ACA markets to see the difference in the way the costs for emergency room and urgent care are split between individuals and their health insurance companies. The results show that for both markets and all metal levels,* insurance companies are more likely to share the cost before the deductible for urgent care than for the emergency room. This means that an individual who has not yet met her deductible might have to shoulder the full cost of an emergency room visit, while the cost for the same visit at urgent care would be shared with her health insurance company.

It’s worth checking your insurance coverage to see the difference in the way emergency room and urgent care visits are covered—it could end up saving you money if you experience an urgent medical condition when the option to see your doctor is not available.

* Platinum and catastrophic plans excluded. Catastrophic plans typically have a deductible equal to the out of pocket maximum, which removes cost-sharing variation. Platinum plans often have a $0 deductible, meaning there is no distinction between before and after the deductible.

This is the first of three posts; in the next post, we will look more deeply at the difference in the way that cost sharing for emergency room and urgent care visits are structured.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

This is the third of three posts on this subject

The Affordable Care Act regulates both the individual and small group health insurance markets, yet these two markets are seldom looked at side by side. While many of the regulations governing plan design and premiums are the same, the markets serve very different populations and different health insurance carriers participate.

In our last post, we investigated how competition in the individual market is related to the premium difference between the individual and small group markets. In this post, we will examine how the premium difference between the individual and small group markets has changed over time.

The data science team at Vericred analyzed the difference in premiums between the lowest cost plans on the individual and small group markets for each metal level to see how the premium difference between these markets has changed over the past few years.* The results show that the individual market was slightly more expensive than the small group market in 2016 and that the individual market became increasingly more expensive than small group market for all metal levels in 2017 and again in 2018. The individual market is showing signs of growth for 2019 after a large number of exits in 2018. Consumers and policy makers should take note as 2019 rate filings are released to see if this trend of divergence in premiums between the individual and small group markets continues or begins to stabilize.

* Trend over time is similar, but less extreme, if the median cost plans for each metal level are used instead of the lowest cost plans

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

This is the second of three posts on this subject

The Affordable Care Act regulates both the individual and small group health insurance markets, yet these two markets are seldom looked at side by side. While many of the regulations governing plan design and premiums are the same, the markets serve very different populations and different health insurance carriers participate.

In our last post, we examined the difference in premiums for the lowest cost silver plans on the individual and small group markets. In this post, we will investigate how competition in the individual market is related to this premium difference.

The data science team at Vericred compared the difference in premiums for the lowest cost plans on the individual and small group markets to the percentage of “one-carrier counties”— counties with only one health insurance carrier offering on-market individual plans.* The results show a moderately strong relationship between lack of competition and increased premiums on the individual market. Of the five states where individual premiums are less expensive than small group, three have no one-carrier counties. The other two, Ohio and Indiana, have approximately half one-carrier counties but have heavy involvement of Medicaid Managed Care Organizations in the individual market, which tend to have somewhat lower premiums than other carrier types. All of the states where individual premiums are the most expensive compared to the small group have either mostly or exclusively one-carrier counties.

* Results are similar if the median cost silver plan is used instead of the lowest cost silver plan

This is the second of three posts; in the next post, we will investigate how the premium difference between the small group and individual markets has changed over time.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

This is the first of three posts on this subject

The Affordable Care Act regulates both the individual and small group health insurance markets, yet these two markets are seldom looked at side by side. While many of the regulations governing plan design and premiums are the same, the markets serve very different populations and different health insurance carriers participate.

The data science team at Vericred analyzed premiums for the lowest cost silver plans on the individual and small group markets to see how they differ by state.* The results show that in nearly every state, the lowest cost silver plans are more expensive on the individual market than on the small group market. The only states where the individual plans are less expensive are Indiana, Ohio, New Jersey, New York, and Rhode Island. Additionally, Vermont has a combined individual and small group market, which ensures no difference in premiums. The largest differences between the individual and small group premiums are seen in Iowa and Wyoming, where the lowest cost individual silver plans cost over $300 more than small group. Small employers thinking about whether to offer group health insurance should consider the difference in premiums between the individual and small group markets that their employees will face.

* Results are similar if the median cost silver plan is used instead of the lowest cost silver plan

This is the first of three posts; in the next post, we will investigate how competition in the individual market is related to the premium difference between the small group and individual markets.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

This is the final post of a three-post series on this subject.

To increase transparency, plans offered under the ACA are given metal levels based on how the cost of care is split between an individual and their health plan. Silver plans must cover 70% of a typical population’s healthcare costs, but plans can use a wide variety of different cost-sharing structures to arrive at this 70%. The deductible – the amount the individual must cover before their plan begins to pay—is one factor that can make a big difference to out-of-pocket costs.

In our last two posts, we examined the deductibles for small group silver plans and found that there is substantial variation in both the median deductible between states and the range of deductibles within each state. In this post, we will compare states’ median deductibles in the small group market to those on the individual market.

The data science team at Vericred analyzed the difference between the deductibles for small group and individual silver plans to see how this relationship varies by state. The results range from the median small group deductible being $2,500 less expensive in North Carolina to $1,750 more expensive in New Mexico. For the majority of states, the small group market has less expensive deductibles than the individual market, however, there are 14 states where the small group deductibles are more expensive. Small employers considering whether to offer group health insurance should consider which aspects of cost-sharing matter most to their employees and how cost-sharing differs between the individual and small group markets in their state.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

This is the second of three posts on this subject

To increase transparency, plans offered under the ACA are given metal levels based on how the cost of care is split between an individual and their health plan. Silver plans must cover 70% of a typical population’s healthcare costs, but plans can use a wide variety of different cost-sharing structures to arrive at this 70%. The deductible—the amount the individual must cover before their plan begins to pay—is one factor that can make a big difference to out-of-pocket costs.

In our last post, we examined the median deductible for small group silver plans by state and found that there is substantial geographic variation by state. In this post, we will explore the variation in deductibles within states.

The data science team at Vericred investigated the range of deductibles for small group silver plans within each state. The results show that every state has silver plans with a wide range of deductibles. Employers shopping for a small group plan should consider which aspects of cost-sharing matter most to their employees, as plans with the same metal level in the same market can vary widely in their cost-sharing.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

This is the first of three posts on this subject

To increase transparency, plans offered under the ACA are given metal levels based on how the cost of care is split between an individual and their health plan. Silver plans must cover 70% of a typical population’s healthcare costs, but plans can use a wide variety of different cost-sharing structures to arrive at this 70%. The deductible – the amount the individual must cover before their plan begins to pay – is one factor that can make a big difference to out-of-pocket costs.

The data science team at Vericred analyzed deductibles for small group silver plans to see how they vary by state. The national median deductible for silver plans is $3,000, but the results show that there is substantial geographic variation ranging from only $2,000 in Massachusetts and California to $4,250 in New Mexico and Iowa.