title: Changes in Consumer Cost-Sharing for Health Plans Sold in the ACA's Insurance Marketplaces, 2015 to 2016.
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.
authors.affiliation: Health Care Department, NORC at the University of Chicago, USA
authors.forename: Jon
authors.initials: J
authors.lastname: Gabel
authors.affiliation: Health Care Department, NORC at the University of Chicago, USA
authors.forename: Matthew
authors.initials: M
authors.lastname: Green
authors.affiliation: Health Care Department, NORC at the University of Chicago, USA
authors.forename: Adrienne
authors.initials: A
authors.lastname: Call
authors.affiliation: Health Care Department, NORC at the University of Chicago, USA
authors.forename: Heidi
authors.initials: H
authors.lastname: Whitmore
authors.affiliation: Health Care Department, NORC at the University of Chicago, USA
authors.forename: Sam
authors.initials: S
authors.lastname: Stromberg
authors.affiliation: Health Care Department, NORC at the University of Chicago, USA
authors.forename: Rebecca
authors.initials: R
authors.lastname: Oran
mesh_terms: D017047:Cost Sharing / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D003669:Deductibles and Coinsurance / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D005544:Forecasting; D006264:Health Benefit Plans, Employee / Q000191:economics; D062265:Health Insurance Exchanges / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D011320:Primary Health Care / Q000191:economics; D014481:United States