Marketplace cost-sharing got more costly between 2015 and 2016

Out of pocket costs—copayments and deductibles—increased between 2015 and 2016 for the 40 percent of enrollees in marketplace plans who were not receiving cost-sharing subsidies. The rise in consumer cost sharing under the Patient Protection and Affordable Care Act (ACA) was identified by University of Chicago researchers as part of a study on changes in consumer health plan cost-sharing—deductibles, copayments, coinsurance, and out-of-pocket limits—between 2015 and 2016. The finding represents a change from the 2014 to 2015 period when cost-sharing amounts for individual and family plans obtained through the state and federal marketplaces remained stable.

Cost-sharing. The study evaluated seven types of cost sharing: (1) out-of-pocket limit; (2) general annual deductible; (3) copayment, primary care provider visit; (4) copayment, specialty visit; (5) copayment, generic drugs; (6) copayment, preferred-brand drugs; and (7) copayment, non-preferred-brand drugs. Among the types of cost sharing, only one—copayments for generic drugs—fell in 2016, decreasing by 3 percent. Out-of-pocket limits, general annual deductibles, and copayments for nonpreferred drugs increased significantly, by 7, 10, and 14 percent, respectively. The study also found that cost-sharing amounts in gold level marketplaces plans were, on average, about equal to cost-sharing amounts for employer-based plans.

Deductibles. Among the marketplace plans offered in 2016 with deductibles, the average deductible was $484 for platinum plans and $5,724 for bronze plans. The marketplace deductibles were, in some cases, both lower and higher than employer-based plan deductibles, which averaged $1,318 in 2015. Between 2015 and 2016, general deductibles increased 10 percent for bronze plans and 5 percent for silver and gold plans. Deductibles decreased by 16 percent for platinum plans over that same period.

Plan mix. The study noted that some of the overall cost increases are attributable to changes in plan mix among marketplace plans. Between 2015 and 2016, the share of platinum and gold plans decreased slightly, while the share of silver and bronze plans increased slightly. In other words, the market shifted towards plans with higher deductibles. Additionally, the annual deductible changes within individual plan tiers—excepting the bronze plans—were smaller than the overall 10 percent deductible changes.

Area for reform. Although an individual who spends more than 10 percent of annual income on medical care or insurance is typically considered underinsured, a single person earning $30,000 a year, enrolled in a silver plan, has an average annual deductible of about $3,000—10 percent of pretax income. As a result, the researchers suggested that cost-sharing reductions can be seen as a potential major area for future reforms.


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