CMS recently announced some big shifts in marketplace enrollment by metal in 2018. Due to the quirks introduced by the elimination of cost-sharing reduction payments (CSRs), subsidy-eligible customers often found they could get better deals by choosing bronze or gold. The share of marketplace enrollees in bronze plans, in particular, increased from 23 percent to 29 percent. Among those new to the marketplace, the trend toward bronze was even greater—34 percent of new enrollees on healthcare.gov chose bronze plans. Yet this shift to bronze may have some unintended consequences for individuals and health care markets, since cost-sharing differs significantly by metal.
Marketplace plans as a rule have high deductibles; the medians for bronze, silver, and gold plans in 2018 are $6,400, $3,800, and $1,250, respectively. But size is not all that matters. Bronze plans not only have the biggest deductibles, but they are also the least likely to have cost-sharing for health services.
There are three main ways that marketplace plans provide cost-sharing before the deductible. The most common (more than 50% of all plans) uses co-insurance or even more often, a co-pay, usually $30. About 15 percent of all plans use one of two volume-dependent options that relate cost-sharing to the number of visits. For example, some plans provide a limited number of no-cost visits, and then switch to a co-pay or co-insurance until the deductible is met. A more austere option is to have a limited number of free or low co-pay visits, after which the deductible must be met. But about 30 percent of all market plans do not permit any cost-sharing at all until the deductible is met.