Some cost-sharing measures rise significantly in ACA marketplace plans

Cost-sharing in Affordable Care Act marketplace plans rose moderately from 2015 to 2016 among the 40 million Americans who aren't eligible for cost-sharing reductions, according to a new analysis from The Commonwealth Fund.

In their examiniation of seven distinct cost-sharing measures, researchers found three that increased significantly in 2016: Out-of-pocket limits rose by 7 percent, general annual deductibles climbed 10 percent and copayments for nonpreferred drugs rose 14 percent. In contrast, copayments for generic drugs decreased by 3 percent.

Deductibles, seen by some as the most important determinant of the share of healthcare expenses, increased by 10 percent for bronze plans and by 5 percent for silver and gold plans, while platinum plans had a 16 percent decrease in deductibles, the study found.


9 Tips for Implementing the Best Mobile App Strategy

The member mobile app is a powerful tool for payers and members. It can help improve health outcomes, reduce operational costs, and drive self-service — anytime, anywhere. In this new eBook, learn tips and tricks to implementing the best mobile app strategy now.

Copayments for primary care visits, meanwhile, ranged from an average of $17 under platinum plans to an average of $43 with bronze coverage. 

Part of the shift, researchers write, is the overall trend of more consumers choosing bronze and silver plans over more comprehensive gold and platinum plans.

In keeping with trends in medical expenses, the researchers note that "insurers will need to increase deductibles, copayments, out-of-pocket limits and other fixed-amount forms of cost-sharing to maintain a constant actuarial value." Even so, they point out that increases in cost-sharing under marketplace plans are likely to be smaller than those in employer-based insurance.

A previous Commonwealth Fund analysis found that average copayments, deductibles and out-of-pocket limits were considerably higher from 2014 to 2015.

To learn more:
- read the analysis

Suggested Articles

HHS will give out $333 million in incentive payments to nursing homes who lowered their COVID-19 case and death counts in September.

Nearly half of employees have deferred care amid the pandemic, according to a new survey from Willis Towers Watson.

It’s more urgent than ever to deliver a better member experience. Learn the proven approach health plans take to implement a winning digital strategy.