Analysis of Cost-Sharing for 2019 Federal Marketplace Plans
The data presented here showcases the cost-sharing details for plans offered in the Federal Marketplace for 2019. It includes insights on the percentage of plans where medical deductibles are combined with or separate from prescription drug deductibles, average medical deductibles for plans with combined and separate deductibles, and income thresholds for different levels of cost-sharing reduction. The analysis is based on information from Healthcare.gov and the Kaiser Family Foundation in 39 states with Federally Facilitated or Partnership Exchanges in 2019.
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Cost-Sharing for Plans Offered in the Federal Marketplace for 2019
Figure 1 Percent of Plans Where Medical Deductible is Combined with or Separate from the Prescription Drug Deductible (2019) 100% 7% 90% 29% 80% 48% 54% 70% Separate Combined 60% 50% 93% 40% 71% 30% 52% 46% 20% 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 2019 (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-2019/
Figure 2 Average Medical Deductible, in Plans with Combined Medical and Prescription Drug Deductibles (2019) $7,000 $6,258 $6,000 $5,000 $4,375 $4,000 $3,000 $2,000 $1,335 $1,000 $48 $0 Bronze Silver Gold Platinum SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 39 states with Federally Facilitated or Partnership exchanges in 2019 (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-2019/
Figure 3 Average Medical Deductible In Plans with Separate Medical and Prescription Drug Deductibles (2019) $7,000 $5,977 $6,000 $5,000 $4,043 $4,000 $3,000 $2,000 $1,581 $1,000 $365 $0 Bronze Silver Gold Platinum SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 39 states with Federally Facilitated or Partnership exchanges in 2019 (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-2019/
Figure 4 Average Medical Deductible In Plans with Combined Medical and Prescription Drug Deductible (2019) $5,000 $4,375 $4,500 $4,000 $3,500 $3,169 $3,000 $2,500 $2,000 $1,500 $843 $1,000 $500 $239 $0 Silver with no CSR: Incomes over 250% of FPL (over $30,350 for a single individual) Silver, CSR 73% AV: Incomes 200%-250% of FPL ($24,280-$30,350 for a single individual) Silver, CSR 87% AV: Incomes 150%-200% of FPL ($18,210-$24,280 for a single individual) Silver, CSR 94% AV: Incomes 100%-150% of FPL ($12,140-$18,210 for a single individual) SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 39 states with Federally Facilitated or Partnership exchanges in 2019 (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-2019/. 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 (2019) $4,500 $4,043 $4,000 $3,500 $3,214 $3,000 $2,500 $2,000 $1,500 $1,000 $683 $500 $175 $0 Silver with no CSR: Incomes over 250% of FPL (over $30,350 for a single individual) Silver, CSR 73% AV: Incomes 200%-250% of FPL ($24,280-$30,350 for a single individual) Silver, CSR 87% AV: Incomes 150%-200% of FPL ($18,210-$24,280 for a single individual) Silver, CSR 94% AV: Incomes 100%-150% of FPL ($12,140-$18,210 for a single individual) SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 39 states with Federally Facilitated or Partnership exchanges in 2019 (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-2019/. 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 (2019) $8,000 $7,374 $7,000 $5,885 $6,000 $5,000 $4,000 $3,000 $2,200 $2,000 $1,073 $1,000 $0 Silver with no CSR: Incomes over 250% of FPL (over $30,350 for a single individual) Silver, CSR 73% AV: Incomes 200%-250% of FPL ($24,280-$30,350 for a single individual) Silver, CSR 87% AV: Incomes 150%-200% of FPL ($18,210-$24,280 for a single individual) Silver, CSR 94% AV: Incomes 100%-150% of FPL ($12,140-$18,210 for a single individual) SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 39 states with Federally Facilitated or Partnership exchanges in 2019 (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-2019/. 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.
