Out-of-Pocket Costs for Advanced Imaging Across the US Private Insurance Marketplace

Journal of the American College of Radiology : JACR
Andrew B RosenkrantzRichard Duszak

Abstract

The aim of this study was to characterize out-of-pocket patient costs for advanced imaging across the US private insurance marketplace. Using the 2017 CMS Health Insurance Marketplace Benefits and Cost Sharing Public Use File, which details coverage policies for qualified health plans on federally facilitated marketplaces, measures of out-of-pocket costs for advanced imaging and other essential health benefits were analyzed for all 18,429 plans. Independent of deductibles, 48.0% of plans required coinsurance (percentage fees) for advanced imaging, 9.7% required copayments (flat fees), and 8.0% required both; 34.3% required neither. For out-of-network services, 91.5% required coinsurance, 0.1% copayments, and 1.0% both; only 7.4% required neither. In the presence of deductibles, patient coinsurance burdens for advanced imaging in and out of network were 27.7% and 47.7%, respectively, and average in- and out-of-network copayments were $319 and $630, respectively. In the presence of deductibles, patients' average coinsurance ranged from 10.0% to 40.9% in network and from 29.1% to 75.0% out of network by state; these tended to be higher in lower income states (r = -0.332). For no-deductible policies, patients' average out-of-networ...Continue Reading

Associated Clinical Trials

Citations

Aug 19, 2020·Multiple Sclerosis : Clinical and Laboratory Research·Gelareh SadighRuth C Carlos
Mar 23, 2021·Current Problems in Diagnostic Radiology·Kartik MedaNadja Kadom
Jul 23, 2021·Journal of the American College of Radiology : JACR·Sean P DoyleGelareh Sadigh

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