Eight Million and Counting

A Deeper Look at Premiums, Cost Sharing and Benefit Design in the New Health Insurance Marketplaces

A first-of-its-kind analysis provides an in-depth look at the cost sharing features of marketplace plans in every state—including deductibles and the services to which they apply. The analysis underscores the importance of examining exchange plan details beyond premiums.

In partnership with RWJF, Breakaway Policy Strategies has compiled and is making available to the public in open source a comprehensive dataset, HIX Compare, containing:

  • Premium information for all 7,027 Silver plans being sold through the ACA health insurance exchanges.
  • Benefit design and cost sharing requirements for all 1,208 unique Silver exchange plans.

Summary of Findings

  • Exchange plan premiums vary widely between states and among rating areas within states. Across all Silver plans, the national average premium is $265 per month for a 27-year-old, $435 per month for a 50-year-old, and $878 for a family of four. The lowest and highest plan premiums are found in Minnesota and Virginia, respectively.

  • Many exchange plans subject health care services such as primary care physician visits and prescription drugs to a deductible, a benefit design feature which is not as common in employer-sponsored insurance plans.

  • Of the 1,208 unique Silver plans analyzed, 641, or about half, offer combined deductibles under which medical and prescription drug expenses accumulate to a single deductible. The average combined deductible for those plans is $2,267.

  • Among the 1,208 unique plans, 1,150 had a combined out-of-pocket maximum, meaning that medical and prescription drug expenses accumulate to the same out-of-pocket maximum.

Download the Data

HIX Compare

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