Changes in Consumer Cost-Sharing for Health Plans Sold in the ACA's Insurance Marketplaces, 2015 to 2016

Issue Brief (Commonw Fund). 2016 May:11:1-14.

Abstract

This brief examines changes in consumer health plan cost-sharing--deductibles, copayments, coinsurance, and out-of-pocket limits--for coverage offered in the Affordable Care Act's marketplaces between 2015 and 2016. Three of seven measures studied rose moderately in 2016, an increase attributable in part to a shift in the mix of plans offered in the marketplaces, from plans with higher actuarial value (platinum and gold plans) to those that have less generous coverage (bronze and silver plans). Nearly 60 percent of enrollees in marketplace plans receive cost-sharing reductions as part of income-based assistance. For enrollees without cost-sharing reductions, average copayments, deductibles, and out-of-pocket limits remain considerably higher under bronze and silver plans than under employer-based plans; cost-sharing is similar in gold plans and employer plans. Marketplace plans are more likely than employer-based plans to impose a deductible for prescription drugs but no less likely to do so for primary care visits.

MeSH terms

  • Cost Sharing / economics
  • Cost Sharing / statistics & numerical data*
  • Cost Sharing / trends
  • Deductibles and Coinsurance / economics
  • Deductibles and Coinsurance / statistics & numerical data*
  • Deductibles and Coinsurance / trends
  • Forecasting
  • Health Benefit Plans, Employee / economics
  • Health Insurance Exchanges / economics
  • Health Insurance Exchanges / statistics & numerical data*
  • Health Insurance Exchanges / trends
  • Humans
  • Insurance, Pharmaceutical Services / economics
  • Insurance, Pharmaceutical Services / statistics & numerical data
  • Insurance, Pharmaceutical Services / trends
  • Patient Protection and Affordable Care Act / economics*
  • Primary Health Care / economics
  • United States