- Read the Report: Coverage When It Counts
From April 2008 through June 2009, researchers at the Georgetown University Health Policy Institute assessed coverage under 10 health plans in Massachusetts. The researchers applied the rules of each health plan to simulated claims for breast cancer, heart disease and diabetes.
For each disease scenario, the research team calculated how much each plan would pay for each step in the treatment process and how much would be left for the patient to pay.
The 10 plans offered a range of deductibles and co-payments. Under Massachusetts law, the plans had an annual out-of-pocket maximum of $5,000. However, one plan, available only to young adults, capped covered benefits at $50,000 annually.
The researchers reported their findings and recommendations in Coverage When it Counts: What Does Health Insurance in Massachusetts Cover and How Can Consumers Know? posted on RWJF’s website in May 2009. Consumer Reports cited the research in a feature article on coverage gaps in its May 2009 issue.