Feds: Cost-sharing lower than assumed in ACA marketplace plans

A vice squeezing a wallet

A new report from the federal government seeks to quell concerns about the rising costs of Affordable Care Act marketplace plans by pointing out that they have lower deductibles and more covered health services than many assume.

The median individual deductible for a Healthcare.gov policy is $850 this year, a decline from $900 in 2015, according to the Centers for Medicare & Medicaid Services. These numbers take into account the fact that about 60 percent of marketplace consumers receive assistance that reduces their deductibles and other cost-sharing obligations.

For those who do not qualify for reduced cost sharing, deductibles are higher--a median of $3,000 for silver plans, the report notes.

Because so many consumer receive cost-sharing assistance, CMS argues its analysis paints a more accurate picture of what consumers pay than anecdotes about marketplace policies with very high cost sharing that focus on high-deductible plans like those in the bronze tier, even though consumers “overwhelmingly” flock toward silver plans.

Overall, about a third of Healthcare.gov enrollees have deductibles less than or equal to $250, and more than half have deductibles below $1,000 in 2016, the report says.

Healthcare.gov plans also cover an average of seven common healthcare services, including generic drugs and primary care visits--as well as preventive care services such as cancer screenings, immunizations and well-child visits--with no or minimal cost-sharing before consumers meet their deductibles, the report notes. Just looking at deductibles “does not provide an accurate picture of marketplace consumers’ access to care,” CMS says.

“As with premiums, marketplace deductibles and out-of-pocket costs in marketplace plans are often lower than advertised thanks to the financial help available,” Health Insurance Marketplace CEO Kevin Counihan said in an announcement.

A previous government report--issued amid mounting worries that 2017 premiums will soar--pointed out that many consumers pay less than the premium rates that insurers request.

- read the report
- here’s the announcement