title: Nearly One-Third Of Enrollees In California's Individual Market Missed Opportunities To Receive Financial Assistance.
abstract: The Affordable Care Act includes financial assistance that reduces both premiums and cost-sharing amounts for lower-income Americans, to increase the affordability of health insurance coverage and care. To receive both types of assistance, enrollees must purchase a qualified health plan through a public insurance exchange, and those eligible for the cost-sharing reduction must purchase a silver-tier plan. We estimate that 31 percent of individual-market enrollees in California who were likely eligible for financial assistance purchased plans that were not silver tier or that were not sold on the state's exchange and thus missed opportunities to receive premium or cost-sharing assistance or both. Lower-income enrollees who chose plans not eligible for subsidies had two to three times higher odds of reporting difficulty paying premiums and out-of-pocket expenses during the year, compared to those who chose eligible plans. Regardless of how the structure of the individual market evolves in the coming years, efforts are likely needed to steer lower-income enrollees away from financially suboptimal plan choices.
authors.affiliation: Vicki Fung (vfung@mgh.harvard.edu) is a senior scientist at the Mongan Institute Health Policy Center, Massachusetts General Hospital, and an assistant professor in the Department of Medicine at Harvard Medical School, both in Boston, Massachusetts.
authors.forename: Vicki
authors.initials: V
authors.lastname: Fung
authors.affiliation: Catherine Y. Liang is a research assistant at the Mongan Institute Health Policy Center, Massachusetts General Hospital.
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Liang
authors.affiliation: Karen Donelan is a senior scientist at the Mongan Institute Health Policy Center, Massachusetts General Hospital, and an associate professor in the Department of Medicine at Harvard Medical School.
authors.forename: Karen
authors.initials: K
authors.lastname: Donelan
authors.affiliation: Cassandra G. K. Peitzman is an MD/PhD candidate in the Graduate School of Arts and Sciences at Harvard University, in Cambridge, Massachusetts, and Harvard Medical School.
authors.forename: Cassandra G K
authors.initials: CG
authors.lastname: Peitzman
authors.affiliation: William H. Dow is a professor in the Division of Health Policy and Management, School of Public Health, at the University of California, Berkeley.
authors.forename: William H
authors.initials: WH
authors.lastname: Dow
authors.affiliation: Alan M. Zaslavsky is a professor in the Department of Health Care Policy at Harvard Medical School.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.affiliation: Bruce Fireman is a biostatistician in the Division of Research at Kaiser Permanente, in Oakland, California.
authors.forename: Bruce
authors.initials: B
authors.lastname: Fireman
authors.affiliation: Stephen F. Derose is a research scientist in the Department of Research and Evaluation at Kaiser Permanente Southern California, in Pasadena.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Derose
authors.affiliation: Michael E. Chernew is a professor in the Department of Health Care Policy at Harvard Medical School.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chernew
authors.affiliation: Joseph P. Newhouse is the John D. MacArthur Professor of Health Policy and Management in the Department of Health Care Policy at Harvard Medical School, the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, and the John F. Kennedy School of Government at Harvard University, and a faculty research fellow at the National Bureau of Economic Research, in Cambridge, Massachusetts.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Newhouse
authors.affiliation: John Hsu is director of the Program for Clinical Economics and Policy Analysis in the Mongan Institute Health Policy Center, Massachusetts General Hospital, and an associate professor in the Department of Medicine and the Department of Health Care Policy at Harvard Medical School.
authors.forename: John
authors.initials: J
authors.lastname: Hsu
mesh_terms: D000328:Adult; D002140:California; D003258:Consumer Behavior; D017047:Cost Sharing / Q000191:economics*; D005260:Female; D005102:Health Expenditures; D062265:Health Insurance Exchanges / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000191:economics; D011795:Surveys and Questionnaires; D014481:United States
keywords: Consumer Issues; Cost of Health Care; Health Economics; Health Reform; Insurance Coverage < Insurance