Max out of Pocket in the ACA

The real test of how good a healthcare plan is can be difficult to assess, but one very crude benchmark is the maximum out of pocket. In layman’s terms, that’s the maximum a subscriber has to pay if the absolute worst happens. In this case, I’m looking at family MOOP. Say a family slid off the road during a snow storm and several people got hurt, they needed expensive surgery and rehab. The max out of pocket is the amount of money that the family would have to pay before the insurance covers everything 100%. I want to take a look at that number.

Here’s a quick glimpse and then some data cleaning.

There’s a lot of plans in there that have a zero family MOOP. That’s not accurate. I will only stick to plans that actually have a dollar amount.

I’m going to map this to see which states have the worst MOOP on average for a family. I used a function that turns state abbreviations to a format that choropleth can actually use.

Idaho is easily the worst. Along with Arizona and New Mexico. Things look pretty uniform throughout the rest of the country, however. I want to look how MOOP has changed over time as well. I only have two years for the ACA: 2014 and 2015. I would like to see if MOOP has gotten higher.

One thing to note here: there are LOTS more total plans in 2015. Almost twice as many, actually. That means I need to think about how to display this visually so I don’t mislead.

Now, this is where things get very interesting. The max MOOP in 2014 was $12,700 and there are many plans with that MOOP. 4253 in total. That’s about a third of all plans at the max MOOP. But then in 2015 things change. The max MOOP goes up to$13,200. And now many plans have higher MOOPs. Now over 9000 plans have family MOOPs of \$12,700+. That’s a huge increase. As the MOOP ceiling has gone up, health insurers have moved their MOOP up as well. That’s a worrying trend.

Remebering that the difference between the total count of plans in 2014 and 2015 is large, I don’t want to use raw numbers. Instead, I want to use percentages to display the information in a way that makes sense.

While the ACA has obviously been a huge benefit to families who need it, it’s a little scary to note that that many plans offer the poorest coverage possible under the ACA. It will be interesting to see what happens over the next five years. Will HHS keep allowing MOOP to rise or will they push back? If this data is any indication, health insurers will continue to raise MOOP if they are allowed.