Most health plans require enrollees to pay a portion of the cost of care when they seek services. While there are lots of forms of cost sharing — deductibles, copayments, coinsurance – people often focus on the deductible amount because it often provides the simplest indication of how generous a plan may be. A deductible is the amount that an enrollee must pay toward the cost of covered services before the plan will start paying for most types of care covered by the plan. Certain preventive services must be covered without cost sharing in all plans in the Affordable Care Act’s Marketplaces, and insurers sometimes pay towards other services, usually physician office visits or prescription drugs, before the enrollee has met his or her deductible. Still, people need to be prepared for the fact that they may need to pay the entire deductible amount out of pocket if they need a significant amount of care during a year.
The slide show provides an initial look at the deductibles for medical care and the specific deductibles applied to prescription drugs for the plans offered in the federally facilitated and partnership Marketplaces available healthcare.gov. The amounts are simple averages of the plans available (see Methods). The amounts are shown separately by metal level (“Bronze,” “Silver,” “Gold,” and “Platinum”). Deductible amounts are shown separately for plans where medical spending and prescription drug spending are both subject to the same deductible (called “combined) and for plans where there are separate deductibles for medical spending and prescription drug spending (called “separate”). Not surprisingly, deductibles tend to decrease as one moves from the levels with lower actuarial values (“Bronze” and “Silver”) to the higher levels.
The slides do not show the deductibles for silver plans that provide reduced cost sharing for people with low incomes (e.g., people receiving cost-sharing subsidies). Many people in Marketplace plans receive these subsidies, and would not be subject to the deductible amounts shown in the slides. We will be releasing a more complete analysis that has information for these plans and for the other types of cost sharing (e.g., copayments, coinsurance amounts) in the near future.
Information on plan cost sharing provisions was downloaded from Healthcare.gov for the plans offered in federally-facilitated and partnership exchanges. Because many plans are offered in multiple rating areas within a state, we reduced the number of plans so that each benefit package was counted only once for each state. The averages and distributions are simple averages of the plans that are available and are not weighted by enrollment because we do not have enrollment for each plan.