But High Deductibles Mean Consumers Might Be Better Off Paying More in Premiums for a Silver Plan That Offers Cost-Sharing Help

6 years ago

As the Affordable Care Act’s open enrollment period nears an end in most areas this week, a new analysis from KFF (the Kaiser Family Foundation) finds that 4.2 million currently uninsured people could get a bronze-level plan for 2019 and pay nothing in premiums after factoring in tax credits.

That works out to 27 percent of the 15.9 million uninsured individuals who could shop in the ACA marketplaces. In some states the share with access to a free bronze plan is far higher, including: Delaware (49%), Nebraska (49%), Iowa (48%), Utah (46%), Alaska (42%), Oklahoma (42%), Wisconsin (42%), Wyoming (41%), and Idaho (40%).

Looked at another way, over half (52%) of the uninsured who could get a free bronze plan live in four states: Texas (1,010,428 people), Florida (623,434), North Carolina (296,892) and Georgia (254,296). The analysis has detailed data on the number and share of the uninsured in each state who have access to a free bronze plan.

However, with bronze deductibles averaging $6,258 a year, getting a $0 premium bronze plan isn’t quite the no-brainer for the uninsured that it initially may seem. Many people eligible for a free bronze plan would also be eligible for significant cost-sharing assistance under the ACA by purchasing a silver plan instead. Silver plans may provide more financial protection, including lower deductibles, for those who get sick and use medical services.

The availability of $0 premium bronze plans arises from insurers’ practice of “silver loading”, the increasing of silver plan premiums in response to the Trump administration’s termination of cost-sharing payments to insurers in late 2017. That triggered higher ACA premium tax credits for consumers (since they are calculated using the second-lowest cost silver plan as a benchmark) and, in turn, made bronze plans more likely to be available for $0 in premiums.

Also available is KFF’s Health Insurance Marketplace Calculator, which allows users to enter their income, age, and family size and get estimates of premiums and available subsidies for insurance purchased on the ACA exchanges. We also have a searchable online archive of 300 frequently asked questions about the ACA and the health insurance Marketplace.