Beyond Premium Subsidies

An Examination of Cost-Sharing Reduction Plans in the ACA Health Insurance Exchanges

Cost-sharing information for silver plans in 10 states is compared and contrasted including out-of-pocket maximums, deductibles and other cost-sharing features.

The Issue

This brief contains analysis based on HIX Compare data for plans available in the 10 states reporting the highest exchange plan enrollment in 2015: Florida, California, Texas, North Carolina, Georgia, Pennsylvania, New York, Virginia, Illinois, and Michigan.

Key Findings

  • Only a few of the CSR plans surveyed include separate out-of pocket maximums for prescription drugs.

  • The differences between standard silver plans and CSR plans are generally more significant among deductibles and out-of-pocket maximums than among cost sharing for specific services.

Conclusion

The authors find the ability of enrollees to easily access and browse cost-sharing information for plans is essential to successful operation of the exchanges.

 

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.

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Health Reform: By The Numbers

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