Given Plan A and Plan B with the same actuarial value (73%), but different deductibles and out-of-pocket maximums, which statement is true?

Given Plan A and Plan B with the same actuarial value (73%), but different deductibles and out-of-pocket maximums, which statement is true?

• A. They are easy pricing plans.
• B. Plan A has a higher deductible than Plan B.
• C. Plan B has a lower out-of-pocket maximum than Plan A.
• D. The plans are not easy pricing plans due to differences in deductible and OOP max

Answer: (D)

Actuarial value shows the share of expected medical costs the plan pays on average after patient cost-sharing, but it doesn’t capture how that cost-sharing is distributed throughout the year. Two plans can both have an actuarial value around 73%, yet one may front-load costs with a higher deductible while the other back-loads costs with a lower deductible but a higher out-of-pocket maximum. Because the timing and amount of what a consumer pays differ, the plans aren’t priced in a straightforward, easily comparable way using AV alone. The different deductible and out-of-pocket maximum structures mean pricing must account for how much a member pays before benefits kick in and how high costs can rise for the member, even though the overall AV is the same. Therefore, these plans are not easy pricing plans due to differences in deductible and OOP max.

Actuarial value shows the share of expected medical costs the plan pays on average after patient cost-sharing, but it doesn’t capture how that cost-sharing is distributed throughout the year. Two plans can both have an actuarial value around 73%, yet one may front-load costs with a higher deductible while the other back-loads costs with a lower deductible but a higher out-of-pocket maximum. Because the timing and amount of what a consumer pays differ, the plans aren’t priced in a straightforward, easily comparable way using AV alone. The different deductible and out-of-pocket maximum structures mean pricing must account for how much a member pays before benefits kick in and how high costs can rise for the member, even though the overall AV is the same. Therefore, these plans are not easy pricing plans due to differences in deductible and OOP max.