Consumers enrolled in a 2016 health insurance Marketplace plan have moderate deductibles and access to several covered health services before reaching the deductible, according to a new analysis by CMS. The median individual deductible is $850 for HealthCare.gov Marketplace policies, and consumers’ plans have an average of seven covered services before the deductible.
“This report shows that Marketplace plans are providing consumers with real financial protections and access to important health services,” said Kevin Counihan, Health Insurance Marketplace CEO. “As with premiums, Marketplace deductibles and out-of-pocket costs in Marketplace plans are often lower than advertised thanks to the financial help available. And most plans cover common health services, like primary care visits and generic drugs, with no or low cost-sharing before consumers meet their deductibles.”
Deductibles can be an important factor in an individual’s plan choice. This year, HealthCare.gov implemented new tools such as an out-of-pocket cost calculator and doctor lookup function to help consumers find a plan that meets their needs and budgets. The new analysis takes into account the fact that about 60% of Marketplace consumers receive financial assistance that reduces their deductibles and other cost-sharing obligations. The median Marketplace deductible decreased from 2015 to 2016.
In addition, all Marketplace plans cover certain preventive services such as cancer screenings, immunizations, and well-child visits without cost-sharing. Most plans also cover other commonly used health services without cost-sharing or with low copayments, even if a consumer has not met the deductible. This coverage means that even though a health plan has a deductible, many consumers face no or low cost-sharing for the services they use frequently.
Nationally, Marketplace plans cover an average of seven types of services before the deductible, most commonly prescription drugs, primary care or specialist visits, and outpatient mental health services.
These findings about the moderate cost-sharing levels in HealthCare.gov Marketplace plans are consistent with other data showing that Marketplace policies are providing consumers with access to care and financial protection. For example, Marketplace consumers report accessing health services, including check-ups, physician services, and prescription drugs, at rates similar to consumers with employer-sponsored coverage. (For more information, go to http://urbn.is/22TLlUP.) Nationally, median out-of-pocket costs (taking into account premiums, deductibles, and other cost-sharing) for consumers purchasing health coverage through the individual market fell by 25% between 2013 and 2014, when the health insurance Marketplace and other individual market reforms in the Affordable Care Act took effect. (For more information, go online to the website http://bit.ly/2cEHCIP.)