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Cost Sharing for Marketplace Enrollees Held Steady in 2015

Jackie Syrop
Cost sharing for marketplace plans remained essentially unchanged from 2014 to 2015, but stable premiums during the period do not reflect the greater costs borne by enrollees, according to a report from The Commonwealth Fund.
An analysis of cost-sharing data from nearly 3000 health insurance plans offered in 2015 in 49 US states and the District of Columbia through state and federal exchanges found that cost sharing for marketplace plans remained essentially unchanged from 2014 to 2015 and that stable premiums during the period do not reflect the greater costs borne by enrollees.

The analysis, from The Commonwealth Fund, examined 8 cost-sharing methods, including deductibles, copayments, coinsurance, and out-of-pocket limits, and compared findings with cost sharing under employer-based insurance.

The report, Consumer Cost-Sharing in Marketplace vs. Employer Health Insurance Plans, 2015, follows a December 2014 report by the authors that found average premiums for health insurance plans for individuals and families obtained through state and federal marketplaces had not changed from 2014 to 2015. The researchers wanted to find out if the December 2014 data meant that insurers increased patient cost sharing by imposing higher deductibles and copayments, and the latest report is an attempt to answer that question.

The report found that cost sharing is greater in catastrophic, bronze, and silver plans than in employer-based coverage plans. The majority of marketplace enrollees are in silver plans (68%), which have very high deductibles and out-of-pocket limits: $2951 and $5866, respectively. The majority (56%) of enrollees in marketplace plans qualified for and were enrolled in coverage with reduced cost-sharing in 2015.

“However, for people without cost-sharing reductions, average copayments, deductibles, and out-of-pocket limits under catastrophic, bronze, and silver plans are considerably higher than under employer-based plans on average, while cost-sharing under gold plans is similar employer-based plans on average,” the authors wrote.

Of 8 cost-sharing methods in marketplace plans, only 2 increased significantly from 2014 to 2015. Out-of-pocket limits rose by nearly 2% and copayments for nonpreferred drugs rose by nearly 3%. Deductibles remained statistically unchanged. Four kinds of cost-sharing methods declined from 2014 to 2015, 2 of which were significant: copayments for generic drugs fell by about 2% and copayments for primary care visits fell by nearly 5%.

The researchers conclude that stable prices for nonemployer health insurance plans obtained through the state and federal exchanges do not reflect cost sharing by enrollees.

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