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.
Standard Criteria for Loss of Ambulation Needed in DMD
April 19th 2024A recent study suggests the differences between ambulation definitions for patients with Duchenne muscular dystrophy (DMD) can impact the identification of ambulant vs nonambulant individuals, and standard criteria across settings are needed.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
An Overview of Health Care and Pharmaceutical Trends, 2023-2024
April 19th 2024Douglas M. Long, BA, MBA, was featured as the keynote speaker on the closing day of The Academy of Managed Care Pharmacy 2024 annual meeting, with a session dedicated to surveying the health care and pharmaceutical trends of the last year.
Read More
Drs Raymond Thertulien, Joseph Mikhael on Racial Disparities in Multiple Myeloma Care Access
December 28th 2023In the wake of the 2023 American Society of Hematology Annual Meeting and Exposition, Raymond Thertulien, MD, PhD, of Novant Health, and Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation, discussed health equity research highlights from the meeting and drivers of racial disparities in multiple myeloma outcomes.
Listen
Real-World Study Reveals Key Insights Into DLBCL Treatment Patterns, Outcomes
April 18th 2024A recent study offers valuable insights into the characteristics, treatment patterns, and outcomes of diffuse large B-cell lymphoma (DLBCL) in patients across different lines of therapy, providing a look into the landscape of DLBCL management.
Read More