Cost-Sharing Analysis of Marketplace Plans in 2016
Explore the cost-sharing details of plans offered in the Federal Marketplace for 2016, including the percentage of plans with combined or separate deductibles, average medical deductibles for different plan types, and income-related breakdowns for CSR availability.
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Cost-Sharing for Plans Offered in the Federal Marketplace for 2016
Figure 1 Percent of Plans Where Medical Deductible is Combined with or Separate from the Prescription Drug Deductible (2016) 100% 11% 90% 80% 44% 57% 70% Separate Combined 73% 60% 50% 89% 40% 30% 56% 43% 20% 27% 10% 0% Bronze Silver Gold Platinum SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 39 states with Federally Facilitated or Partnership exchanges in 2016 (including Arkansas, New Mexico, Oregon, Kentucky and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information-2016/
Figure 2 Average Medical Deductible, in Plans with Combined Medical and Prescription Drug Deductibles (2016) $7,000 $6,000 $5,765 $5,000 $4,000 $3,064 $3,000 $2,000 $1,247 $1,000 $21 $0 Bronze Silver Gold Platinum SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 39 states with Federally Facilitated or Partnership exchanges in 2016 (including Arkansas, New Mexico, Oregon, Kentucky and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information-2016/
Figure 3 Average Medical Deductible In Plans with Separate Medical and Prescription Drug Deductibles (2016) $6,000 $5,500 $5,000 $4,000 $3,198 $3,000 $2,000 $1,136 $1,000 $409 $0 Bronze Silver Gold Platinum SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 39 states with Federally Facilitated or Partnership exchanges in 2016 (including Arkansas, New Mexico, Oregon, Kentucky and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information-2016/
Figure 4 Average Medical Deductible In Plans with Combined Medical and Prescription Drug Deductible (2016) $3,500 $3,064 $3,000 $2,491 $2,500 $2,000 $1,500 $1,000 $709 $500 $221 $0 Silver with no CSR: Incomes over 250% of FPL (over $29,425 for a single individual) Silver, CSR 73% AV: Incomes 200%-250% of FPL ($23,540-$29,425 for a single individual) Silver, CSR 87% AV: Incomes 150%-200% of FPL ($17,655-$23,540 for a single individual) Silver, CSR 94% AV: Incomes 100%-150% of FPL ($11,770-$17,655 for a single individual) SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 39 states with Federally Facilitated or Partnership exchanges in 2016 (including Arkansas, New Mexico, Oregon, Kentucky and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information-2016/. FPL refers to Federal Poverty Level. CSR refers to Cost-Sharing Reduction. AV refers to Actuarial Value. Income cut-offs are poverty thresholds for a household of one.
Figure 5 Average Medical Deductible In Plans with Separate Medical and Prescription Drug Deductibles (2016) $3,500 $3,198 $3,000 $2,553 $2,500 $2,000 $1,500 $1,000 $617 $500 $145 $0 Silver with no CSR: Incomes over 250% of FPL (over $29,425 for a single individual) Silver, CSR 73% AV: Incomes 200%-250% of FPL ($23,540-$29,425 for a single individual) Silver, CSR 87% AV: Incomes 150%-200% of FPL ($17,655-$23,540 for a single individual) Silver, CSR 94% AV: Incomes 100%-150% of FPL ($11,770-$17,655 for a single individual) SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 39 states with Federally Facilitated or Partnership exchanges in 2016 (including Arkansas, New Mexico, Oregon, Kentucky and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information-2016/. FPL refers to Federal Poverty Level. CSR refers to Cost-Sharing Reduction. AV refers to Actuarial Value. Income cut-offs are poverty thresholds for a household of one.
Figure 6 Average Out-Of-Pocket Limit In Plans with Combined Limit for Medical and Prescription Drug Cost Sharing (2016) $7,000 $6,160 $6,000 $4,850 $5,000 $4,000 $3,000 $1,795 $2,000 $874 $1,000 $0 Silver with no CSR: Incomes over 250% of FPL (over $29,425 for a single individual) Silver, CSR 73% AV: Incomes 200%-250% of FPL ($23,540-$29,425 for a single individual) Silver, CSR 87% AV: Incomes 150%-200% of FPL ($17,655-$23,540 for a single individual) Silver, CSR 94% AV: Incomes 100%-150% of FPL ($11,770-$17,655 for a single individual) SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 39 states with Federally Facilitated or Partnership exchanges in 2016 (including Arkansas, New Mexico, Oregon, Kentucky and Nevada). Data are from Healthcare.gov. Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information-2016/. FPL refers to Federal Poverty Level. CSR refers to Cost-Sharing Reduction. AV refers to Actuarial Value. Income cut-offs are poverty thresholds for a household of one.
