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Medical and Prescription Drug Deductibles

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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.

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Medical and Prescription Drug Deductibles
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Percent of Plans Where Medical Deductible is Combined with or Separate from the Prescription Drug Deductible 91% 55% 37% 38% 9% 45% 63% 62% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Bronze Silver Gold Platinum Separate Combined
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Average Medical Deductible, in Plans with Combined Medical and Prescription Drug Deductibles $5,328 $2,556 $845 $69 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 Bronze Silver Gold Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for all Plans with Combined Medical and Prescription Drug Deductible 2% 11% 39% 47% 5% 9% 41% 38% 6% 42% 45% 11% 96% 4% 0% 20% 40% 60% 80% 100% 120% $500 or less >$500 - $1500 >1500-$2500 >2500-$4000 >4000-$5500 Over $5500 Bronze Silver Gold Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Bronze Plans with Combined Medical and Prescription Drug Deductible 0% 2% 11% 30% 34% 22% 0% 5% 10% 15% 20% 25% 30% 35% 40% $2000 or less >$2000 -$2500 >$2500 - $4000 >$4000 - $5000 >$5000 - $6000 Over $6000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Silver Plans with Combined Medical and Prescription Drug Deductibles 4% 9% 41% 38% 7% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% $0 >0 - $1500 >$1500 -$2500 >$2500 - $4000 Over $4000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Gold Plans with Combined Medical and Prescription Drug Deductibles 27% 15% 25% 20% 8% 5% 0% 5% 10% 15% 20% 25% 30% $0 >0 - $500 >$500-$1000 >$1000 - $1500 >$1500 - $2000 Over $2000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles for Platinum Plans with Combined Medical and Prescription Drug Deductibles 84% 13% 4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% $0 >0 - $500 Over $500
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Average Medical Deductible In Plans with Separate Medical and Prescription Drug Deductibles $5,372 $3,453 $1,431 $418 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 Bronze Silver Gold Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for all Plans with Separate Medical and Prescription Drug Deductible 2% 6% 48% 43% 2% 4% 24% 42% 20% 8% 17% 58% 14% 10% 71% 29% 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 $500 or less >$500 - $1500 >1500-$2500 >2500-$4000 >4000-$5500 Over $5500 Bronze Silver Gold Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Bronze Plans with Separate Medical and Prescription Drug Deductibles 2% 6% 40% 31% 19% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% $2500 or less >$2500 -$4000 >4000 - $5000 >$5000 - $6000 Over $6000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Silver Plans with Separate Medical and Prescription Drug Deductibles 2% 15% 31% 24% 19% 9% 0% 5% 10% 15% 20% 25% 30% 35% $0 >$0 - $2000 $>2000 -$3000 >$3000 - $4000 >$4000 - $5000 Over $5000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Gold Plans with Separate Medical and Prescription Drug Deductibles 3% 14% 26% 31% 7% 18% 0% 5% 10% 15% 20% 25% 30% 35% $0 >$0 - $500 >$500-$1000 >$1000 - $1500 >$1500 - $2000 Over $2000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Platinum Plans with Separate Medical and Prescription Drug Deductibles 30% 41% 29% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% $0 >$0 - $500 Over $500

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Medical and Prescription Drug Deductibles

  • 1. Medical and Prescription Drug Deductibles
  • 2. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Percent of Plans Where Medical Deductible is Combined with or Separate from the Prescription Drug Deductible 91% 55% 37% 38% 9% 45% 63% 62% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Bronze Silver Gold Platinum Separate Combined
  • 3. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Average Medical Deductible, in Plans with Combined Medical and Prescription Drug Deductibles $5,328 $2,556 $845 $69 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 Bronze Silver Gold Platinum
  • 4. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for all Plans with Combined Medical and Prescription Drug Deductible 2% 11% 39% 47% 5% 9% 41% 38% 6% 42% 45% 11% 96% 4% 0% 20% 40% 60% 80% 100% 120% $500 or less >$500 - $1500 >1500-$2500 >2500-$4000 >4000-$5500 Over $5500 Bronze Silver Gold Platinum
  • 5. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Bronze Plans with Combined Medical and Prescription Drug Deductible 0% 2% 11% 30% 34% 22% 0% 5% 10% 15% 20% 25% 30% 35% 40% $2000 or less >$2000 -$2500 >$2500 - $4000 >$4000 - $5000 >$5000 - $6000 Over $6000
  • 6. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Silver Plans with Combined Medical and Prescription Drug Deductibles 4% 9% 41% 38% 7% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% $0 >0 - $1500 >$1500 -$2500 >$2500 - $4000 Over $4000
  • 7. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Gold Plans with Combined Medical and Prescription Drug Deductibles 27% 15% 25% 20% 8% 5% 0% 5% 10% 15% 20% 25% 30% $0 >0 - $500 >$500-$1000 >$1000 - $1500 >$1500 - $2000 Over $2000
  • 8. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles for Platinum Plans with Combined Medical and Prescription Drug Deductibles 84% 13% 4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% $0 >0 - $500 Over $500
  • 9. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Average Medical Deductible In Plans with Separate Medical and Prescription Drug Deductibles $5,372 $3,453 $1,431 $418 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 Bronze Silver Gold Platinum
  • 10. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for all Plans with Separate Medical and Prescription Drug Deductible 2% 6% 48% 43% 2% 4% 24% 42% 20% 8% 17% 58% 14% 10% 71% 29% 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 $500 or less >$500 - $1500 >1500-$2500 >2500-$4000 >4000-$5500 Over $5500 Bronze Silver Gold Platinum
  • 11. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Bronze Plans with Separate Medical and Prescription Drug Deductibles 2% 6% 40% 31% 19% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% $2500 or less >$2500 -$4000 >4000 - $5000 >$5000 - $6000 Over $6000
  • 12. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Silver Plans with Separate Medical and Prescription Drug Deductibles 2% 15% 31% 24% 19% 9% 0% 5% 10% 15% 20% 25% 30% 35% $0 >$0 - $2000 $>2000 -$3000 >$3000 - $4000 >$4000 - $5000 Over $5000
  • 13. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Gold Plans with Separate Medical and Prescription Drug Deductibles 3% 14% 26% 31% 7% 18% 0% 5% 10% 15% 20% 25% 30% 35% $0 >$0 - $500 >$500-$1000 >$1000 - $1500 >$1500 - $2000 Over $2000
  • 14. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including 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/ Distribution of Medical Deductibles, for Platinum Plans with Separate Medical and Prescription Drug Deductibles 30% 41% 29% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% $0 >$0 - $500 Over $500