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State health plans have high deductibles, says study

WASHINGTON — You might be pleased with the low monthly premium for one of the new health insurance plans under President Obama’s overhaul, but the added expense of copayments and deductibles could burn a hole in your wallet.

An independent analysis released Wednesday, on the heels of an administration report emphasizing affordable premiums, is helping to fill out the bottom line for consumers.

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The annual deductible for a midrange ‘‘silver’’ plan averaged $2,550 in a sample of six states studied by Avalere Health, or more than twice the typical deductible in employer plans. A deductible is the amount consumers must pay each year before their plan starts picking up the bills.

Americans looking for a health plan in new state insurance markets that open next week will face a trade-off familiar to purchasers of automobile coverage: to keep your premiums manageable, you agree to pay a bigger chunk of the repair bill if you get in a crash. Except that unlike an auto accident, serious illness is often not a self-contained event.

Avalere also found that the new plans will require patients to pay a hefty share of the cost — 40 percent on average — for certain drugs, like the newer specialty medications used to treat intractable chronic diseases such as rheumatoid arthritis and multiple sclerosis. On the other hand, preventive care will be free of charge to the patient.

‘‘Consumers will need to balance lower monthly premiums against the potential for unpredictable, expensive out-of-pocket costs in plans with higher deductibles,’’ said Caroline Pearson, a vice president of the market analysis firm. ‘‘There is a risk that patients could forgo needed care when faced with high up-front deductibles.’’

Responding to the Avalere study, the Obama administration acknowledged the new plans are not as generous as employer coverage, but said they nonetheless represent a big improvement over currently available individual policies, which can have gaps in coverage and even larger out-of-pocket costs.

AFFORDABLE Health care

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Also on Wednesday, the administration unveiled premiums and plan choices for 36 states where the federal government is taking the lead to cover uninsured residents. Insurance markets that go live Oct. 1 will offer subsidized private coverage to people who do not have insurance on the job and those who currently buy their own policies.

Before new tax credits that work like a discount for most consumers, premiums for a midrange benchmark plan will average $328 a month nationally for an individual, the administration report said. Beneath that average are wide differences for individuals, depending on where they live, how much they make, and other factors.

Health and Human Services Secretary Kathleen Sebelius said the average consumer will be able to choose among more than 50 plan options.

‘‘For millions of Americans, these new options will finally make health insurance work within their budgets,’’ Sebelius told reporters in a preview call Tuesday. The markets — called ‘‘exchanges’’ in some states — are the only places where consumers will be able to get a tax credit for health insurance.

Health and Human Services estimated that about 95 percent of consumers will have two or more insurers to choose from. And the administration says premiums will generally be lower than what congressional budget experts estimated when the law was being debated.

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