Take Two Aspirin: An Examination of Physician Visit Cost Sharing and Benefit Design in the New Health Insurance Marketplaces

This issue brief provides physician visit cost sharing and benefit design analysis for silver-level plans, including deductible information, copays and coinsurance ranges.  

The brief's data were taken from Breakaway Policy Strategies' comprehensive dataset, HIX Compare, containing:

  • Benefit design and cost sharing requirements for all 1,208 unique silver-level exchange plans.

Key Findings

  • Coinsurance ranges from 0 percent to 50 percent for primary care physician (PCP) visits, and from 8 to 100 percent for specialist visits.

  • Copayments range from $0 to $75 for PCP visits and $10 to $150 for specialist visits.

  • 68 percent of plans charge a copayment before the deductible for a PCP visit.

  • 32 percent of plans subject PCP visits to a deductible and 39 percent subject specialist visits to a deductible.

About The Grantee

Breakaway Policy Strategies provides research, analysis, practical advice and strategic solutions to guide stakeholders in navigating the transformative changes taking place in the American health care system.

Featured Collection

Health Reform: By The Numbers

Timely data and analysis on key issues related to Affordable Care Act (ACA) coverage expansion and ACA implementation and impact.

Browse this collection