Emergency room cost sharing

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This document analyzes emergency room cost sharing structures across different metal tier health plans offered on the ACA marketplace exchanges. It finds that bronze level plans most commonly feature coinsurance for ER costs, while silver and higher plans tend to use copayment structures more often. The average ER copayment amount increases as plan quality rises from bronze to platinum. Coinsurance rates for ER costs also increase from bronze to platinum metal level plans.

Health & Medicine

SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
38%
12% 9%
2%
9%
33% 43% 56%
37%
32% 22%
25%
16%
22%
26%
17%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Copay & Coinsurance
Coinsurance
Copayment
No Charge after Deductible
Share of Plans by Type of Emergency Room Cost Sharing

The document discusses out-of-pocket maximums for different types of health insurance plans. It shows that on average, bronze plans in 2016 had an out-of-pocket maximum of $6,646, silver plans averaged $6,160, gold plans averaged $4,762, and platinum plans averaged $2,437. It also shows the distribution of out-of-pocket maximums among plans, with most silver plans having a maximum between $6,850 and $4,500.

Inpatient Physicians Cost Sharing

KFF

The document analyzes cost sharing structures for inpatient physician services across different metal level health plans for 37 states in 2015. It finds that bronze plans most commonly featured coinsurance (57%), while silver, gold, and platinum plans increasingly featured copays or no costs after deductibles are met. On average, coinsurance rates were highest for bronze plans at 32% and decreased with more generous plan levels. The majority of bronze plans had coinsurance rates over 30%.

Separate drug deductibles

KFF

The document analyzes prescription drug deductibles in health plans offered on the Affordable Care Act marketplace exchanges in 2016. It finds that the average prescription drug deductible was highest ($404) for bronze-level plans and lowest ($12) for platinum-level plans. For bronze plans, 47% had a $0 drug deductible while for silver and gold plans over half had no drug deductible. The majority (93%) of platinum plans also had a $0 drug deductible.

Inpatient Facility Cost Sharing

KFF

The document analyzes cost sharing structures for inpatient facility costs among Marketplace plans in 37 states in 2015. It finds that bronze plans most commonly involved coinsurance or copayments plus coinsurance for inpatient costs, while silver, gold, and platinum plans increasingly involved only copayments or no costs after deductibles. Average copayments per day or stay were highest for bronze plans at $780 and decreased as plan levels increased to platinum. Coinsurance rates also decreased from an average of 32% for bronze to 20% for gold and platinum plans.

Emergency Room Cost Sharing

KFF

The document analyzes emergency room cost sharing structures across different metal tier health plans offered on the Affordable Care Act exchanges. It finds that bronze level plans most commonly feature coinsurance for emergency room costs, while silver and higher plans tend to use copayments more often. On average, emergency room copayments range from $155 for platinum plans to $264 for bronze plans, while coinsurance rates average from 20% for gold plans to 32% for bronze plans.

Prescription drug cost sharing

KFF

The document analyzes data from 2016 Marketplace plans in 38 states to show trends in prescription drug cost sharing structures. It finds that bronze and silver plans more commonly have deductibles for generic drugs, while gold and platinum plans typically use copays. Copays and coinsurance amounts for generics are lowest in platinum plans and highest in bronze. Preferred drugs generally have higher copays than generics, while non-preferred drugs have the highest copays and more commonly require meeting a deductible first in bronze and silver plans.

Specialist and primary care physician office visits

KFF

The document analyzes cost-sharing structures for primary care physician and specialist visits across bronze, silver, gold, and platinum level plans from ACA marketplaces. It finds that higher metal level plans generally have lower out-of-pocket costs, with platinum plans most commonly having no charges after deductibles are met or offering copayment structures. Lower level bronze plans more frequently require coinsurance payments or charges after deductibles for physician visits. The data also shows the distribution of specific copayment amounts and coinsurance rates across plan categories and metals.

Out-of-Pocket Maximums

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This document analyzes cost sharing structures for inpatient physician services across different metal level health plans from the 2016 marketplace. It finds that bronze plans most commonly feature coinsurance or copayments plus coinsurance (57%), while higher metal level plans are more likely to have copayments only or no costs after deductible is met. The average coinsurance rate decreases from 34% in bronze to 17% in platinum plans. Finally, it shows that lower metal level plans have higher coinsurance rates, with over half of bronze plans having rates over 30%.

Medical and prescription drug deductibles

KFF

The document analyzes medical and prescription drug deductibles of plans in 38 states' health insurance marketplaces in 2016. It shows that the majority of bronze and silver plans combined the medical and prescription drug deductibles, while most gold and platinum plans separated them. Bronze plans had the highest average deductible amounts, while platinum plans had the lowest. Deductible amounts varied significantly depending on the plan's metal tier and whether deductibles were combined or separate.

Separate Drug Deductibles

KFF

The document analyzes prescription drug deductibles in health plans offered on the Affordable Care Act marketplaces in 2015. It finds that the average prescription drug deductible was highest at $465 for bronze plans and lowest at $133 for gold plans. For bronze plans, over half had a $0 prescription drug deductible, while for silver and gold plans over half had no separate prescription drug deductible.

Inpatient facility cost sharing

KFF

The document analyzes cost sharing structures for inpatient facility costs among Marketplace plans in 38 states in 2016. It finds that bronze plans most commonly featured coinsurance or copayments plus coinsurance, while silver and higher tier plans increasingly featured only copayments. The average copayment was highest for bronze plans ($777 per day) and lowest for platinum ($325). Coinsurance rates were also highest for bronze plans (33%) and lowest for platinum (17%).

Specialist and Primary Care Physician Office Visits

KFF

The document analyzes cost-sharing structures for primary care physician and specialist visits across metal-tier health plans for 37 states in 2015. It finds that higher metal-tier plans like gold and platinum generally had lower copays and coinsurance rates for visits compared to bronze plans. For primary care, over 70% of silver plans and over 80% of gold plans had a copayment structure, while over 30% of bronze plans had coinsurance or no charge after deductible. Average copays for primary care ranged from $19 for platinum to $37 for bronze plans.

Cost-Sharing Subsidies in Federal Marketplace Plans

KFF

The document analyzes cost-sharing structures for health plans offered on the ACA marketplaces in 2015. It finds that marketplace plans with higher actuarial values (CSR87 and CSR94) generally had lower deductibles, out-of-pocket costs, and copays than lower-value plans (CSR73). Across all plan types, deductibles and other cost-sharing declined as actuarial value increased. The analysis provides detailed breakdowns of cost-sharing structures for medical, drug, inpatient and outpatient services across the different plan actuarial value levels.

Prescription Drug Cost Sharing

KFF

This document analyzes prescription drug cost sharing structures in health insurance plans from the ACA marketplaces in 2015. It finds that bronze level plans generally had higher copays and coinsurance rates compared to silver, gold, and platinum plans. For generic drugs, over 50% of bronze plans had copays of $10 or less, decreasing to around 25% for silver and higher metal level plans. Specialty drug costs were highest, with average copays of $174-179 and over 50% of bronze plans having copays over $150.

Medical and Prescription Drug Deductibles for Plans Offered in Federally Faci...

KFF

Medical and Prescription Drug Deductibles

KFF

The document analyzes medical and prescription drug deductibles of plans offered on the Affordable Care Act marketplace exchanges in 37 states in 2015. It finds that bronze level plans most often have combined medical and prescription drug deductibles, while silver, gold, and platinum plans more commonly have separate deductibles. Medical deductible amounts vary significantly depending on the plan level, with higher deductibles for bronze and silver plans and lower amounts for gold and platinum plans.

Cost sharing twenty seventeen

KFF

This document contains 6 figures that analyze cost-sharing details for health plans offered on the Federal Health Insurance Marketplace in 2017. Figure 1 shows that the majority of bronze and silver plans had combined medical and prescription drug deductibles, while gold and platinum plans usually had separate deductibles. Figures 2-5 compare the average medical deductible amounts for different metal-level plans and for silver plans with or without cost-sharing reductions. Figure 6 looks at average out-of-pocket limits for silver plans when medical and drug costs were subject to a combined limit.

Cost sharing twenty fifteen

KFF

This document analyzes cost-sharing structures for health plans offered on the federal marketplace in 2015. It finds that the majority of bronze and silver plans combined the medical and prescription drug deductibles, while gold and platinum plans typically separated them. On average, deductibles were highest for bronze plans and lowest for platinum plans, whether the deductibles were combined or separate. Deductibles were also generally lower for silver plans that included cost-sharing subsidies for lower-income enrollees.

Cost sharing twenty nineteen

KFF

The document analyzes cost-sharing structures for health plans offered on the Federal Marketplace in 2019. It finds that the majority of bronze and silver plans combine the medical and prescription drug deductibles, while gold and platinum plans usually have separate deductibles. On average, deductibles are highest for bronze plans and lowest for platinum plans. Additionally, silver plans offering cost-sharing reductions have lower deductibles for people with incomes at or below 250% of the federal poverty level.

Cost sharing twenty sixteen

KFF

This document analyzes cost-sharing features of health plans offered on the ACA marketplaces in 2016, including deductibles and out-of-pocket limits. It finds that most bronze and silver plans combine the medical and prescription drug deductibles, while gold and platinum plans usually separate them. Deductibles are highest in bronze plans and lowest in platinum plans. Silver plans' deductibles vary based on income and cost-sharing subsidies. Out-of-pocket limits that combine medical and drug costs also decrease with more generous silver plan variations and higher metal levels.

Cost sharing twenty fourteen 11.14

KFF

The document analyzes cost-sharing structures for health plans offered on the Federal Marketplace in 2014. It contains 6 figures that show: 1) Most plans had combined rather than separate medical and prescription drug deductibles; 2) Average deductibles decreased as metal levels increased from Bronze to Platinum; 3) Silver plans with cost-sharing reductions had lower deductibles for lower-income enrollees; 4) Out-of-pocket maximums also decreased with income-based cost-sharing in Silver plans.

Cost sharing twenty eighteen

KFF

The document analyzes cost-sharing structures for health plans offered on the Federal Marketplace in 2018. It finds that 92% of bronze plans and 59% of silver plans combine the medical and prescription drug deductibles, while separate deductibles are more common in gold and platinum plans. Average deductibles are highest in bronze plans and lowest in platinum plans, and deductibles are reduced for lower-income enrollees receiving cost-sharing subsidies in silver plans.

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Cost-sharing for Plans Offered in the Federal Marketplace for 2020

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The document analyzes cost-sharing structures for health plans offered on the federal Affordable Care Act marketplace in 2020. It finds that the majority of bronze and silver plans combine the medical and prescription drug deductibles, while gold and platinum plans usually have separate deductibles. Bronze plans have the highest average deductible at $6,506 for combined plans. Deductibles vary based on the level of cost-sharing subsidies provided to enrollees based on their income.

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