eHealth’s analysis finds only 25% of plans cover Rx drugs before medical deductibles are met; HMOs now make up 60% of plans sold on exchange

MOUNTAIN VIEW, Calif.--Dec. 12, 2016-- Today eHealth, Inc. (NASDAQ: EHTH) (eHealth.com), the nation’s first and largest private online health insurance exchange, published an analysis of 2017 Qualified Health Plans (QHPs) available for enrollment using a government subsidy (premium tax credit).

eHealth’s analysis found substantial changes in the plans available in 2017 compared to those available in 2016, as well as notable variations in cost-sharing for prescription drugs.

Depending on which plans they enroll in, consumers could save a significant amount of money in out-of-pocket costs by carefully selecting plans that cover their prescription drugs and using doctors that are part of their health plan’s preferred provider network.

Highlights of eHealth’s analysis include the following:

• 30% decrease in PPO plans, 39% decrease in POS plans, 10% decrease in HMO plans, and 19% decrease in EPO plans – The total number of QHPs available for consumers to choose from decreased 19% in 2017, with the largest decreases coming in the number of available PPO (Preferred Provider Organization) and POS (Point Of Service) plan options.
• 75% of plans only cover prescription drugs after medical deductibles are met – QHPs without separate prescription drug deductibles typically do not cover branded prescription drugs until the medical deductible has been satisfied, though many cover generic drugs and some branded drugs with a co-payment.

“There may be fewer Qualified Health Plans to choose from, but the decision is as complex as ever if you want to save money and get the coverage you need,” said Tom Tsao, eHealth’s President, Small Business, Individual & Family Products. “Excellent decision support tools, like those we offer at eHealth.com, and support from licensed health insurance agents, can make all the difference when it comes to picking the right plan.”

Qualified Health Plans by metal level (Catastrophic, Bronze, Silver, Gold, and Platinum)

Overall, the total number of QHPs available declined 19% in 2017. The number of catastrophic-level health plans (available primarily to those under age 30) decreased by 15%, while all other metal levels declined as well. The largest decline was in the number of platinum plans, which decreased by 63%.

Metal level				2016				2017				2016-2017
				plans				plans				change
Bronze				1,185				996				-16%
Catastrophic				268				229				-15%
Gold				851				530				-38%
Platinum				139				51				-63%
Silver				1,427				1,320				-7%
All metals				3,870				3,126				-19%

Health plans by type (HMO, PPO, EPO and POS)

From 2016 to 2017, the number of QHP PPO plans and POS plans declined 30% and 39%, respectively. The number of HMO plans and EPO plans also declined. The number of HMO plans available fell by 10% while the number of EPO plans fell by 19%.

HMO & PPO Plan Count Data
HMO				2016				2017				2016-2017				PPO plans				2016				2017				2016-2017
plans				HMO				HMO				change								PPO				PPO				change
				plans				plans												plans				plans
Bronze				638				591				-7%				Bronze				308				242				-21%
Catastrophic				149				125				-16%				Catastrophic				72				66				-8%
Gold				465				332				-29%				Gold				231				127				-45%
Platinum				84				28				-67%				Platinum				26				6				-77%
Silver				735				792				+8%				Silver				385				275				-29%
All metals				2,071				1,868				-10%				All metals				1,022				716				-30%

POS & EPO Plan Count Data
POS				2016				2017				2016-2017				EPO plans				2016				2017				2016-2017
plans				POS				POS				change								EPO				EPO				change
				plans				plans												plans				plans
Bronze				146				81				-45%				Bronze				93				82				-12%
Catastrophic				32				27				-16%				Catastrophic				15				11				-27%
Gold				85				29				-66%				Gold				70				42				-40%
Platinum				19				9				-53%				Platinum				10				8				-20%
Silver				154				120				-22%				Silver				153				133				-13%
All metals				436				266				-39%				All metals				341				276				-19%

Health plans with separate prescription drug deductibles by metal level

The number of QHPs that offer a separate (and typically smaller) deductible for prescription drugs declined in 2017. In 2016, one-in-three plans (33%) covered prescription drugs before the medical deductible was met. In 2017, the number of plans that cover prescriptions before the medical deductible fell to one-in-four (25%).

Without a separate prescription drug deductible, consumers are typically required to meet their entire medical deductible before their health plan covers the cost of prescription drugs, though tier-one generic medications are often covered with a copay before any deductible is paid.

Metal Level				2016 plans				2017 plans				2015-2016
				without a separate				without				change
				Rx deductible				a separate Rx
								deductible
Bronze				91%				90%				-1%
Catastrophic				100%				100%				0%
Gold				43%				54%				+11%
Platinum				20%				41%				+21%
Silver				57%				69%				+12%
All metals				66%				75%				+9%

Research Methodology

• Health plans by metal level and by type (HMO, PPO, EPO, and POS): In order to assess year-over-year changes the number of plans of each plan type at various metal levels, eHealth analyzed information on Qualified Health Plans (QHPs) using government-published landscape files for plan years 2016 and 2017 which are available online at: https://www.healthcare.gov/health-and-dental-plan-datasets-for-researchers-and-issuers/.
• Health plans with separate prescription drug deductibles by metal level: eHealth analyzed information on QHPs using government-published landscape files for plan years 2016 and 2017 to determine how many plans included a separate deductible for prescription drugs and the average deductible for plans at various metal levels.
• Plan details may vary: The details of individual QHPs, such as how deductibles are calculated and applied, may vary by each individual QHP. For purposes of this analysis, certain assumptions were made about how deductibles and other plan details typically work. Such assumptions may not accurately reflect each QHP’s actual plan details.

eHealth

eHealth, Inc. (NASDAQ: EHTH) owns eHealth.com, the nation's first and largest private online health insurance exchange where individuals, families and small businesses can compare health insurance products from leading insurers side by side and purchase and enroll in coverage online. eHealth offers thousands of individual, family and small business health plans underwritten by many of the nation's leading health insurance companies. eHealth (through its subsidiaries) is licensed to sell health insurance in all 50 states and the District of Columbia. eHealth also offers educational resources and powerful online and pharmacy-based tools to help Medicare beneficiaries navigate Medicare health insurance options, choose the right plan and enroll in select plans online through Medicare.com (www.Medicare.com), eHealthMedicare.com (www.eHealthMedicare.com) and PlanPrescriber.com (www.PlanPrescriber.com).

For more health insurance news and information, visit eHealth's Consumer Resource Center.

 

View source version on businesswire.com: http://www.businesswire.com/news/home/20161212005242/en/

Source: eHealth, Inc.

DMA Communications for eHealth, Inc.
Sande Drew, 916-207-7674
sande.drew@ehealth.com
or
eHealth, Inc.
Nate Purpura, 650-210-3115
nate.purpura@ehealth.com