Analysis of Cost Sharing for Federal Marketplace Plans in 2023
The analysis of cost-sharing for healthcare plans offered in the Federal Marketplace for 2023 reveals insights on the percentage of plans where medical deductibles are combined or separate from prescription drug deductibles, average medical deductibles in plans, distribution of medical deductibles among different plan tiers, and changes in deductibles from 2022 to 2023. The data sheds light on trends in deductible structures and amounts across different plan categories. Findings will be valuable for consumers choosing health insurance plans in the marketplace.
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Cost-Sharing for Plans Offered in the Federal Marketplace for 2023
Figure 1 Percent of Plans Where Medical Deductible is Combined or Separate from the Prescription Drug Deductible (2023) Combined Separate 100% 10% 13% 15% 90% 31% 80% 70% 60% 50% 90% 87% 85% 40% 69% 30% 20% 10% 0% Bronze Silver Gold Platinum SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2023. Data are from Healthcare.gov.
Figure 2 Average Medical Deductible in Plans with Combined Medical and Prescription Drug Deductibles (2023) $8,000 $7,481 $7,000 $6,000 $4,890 $5,000 $4,000 $3,000 $2,000 $1,650 $1,000 $45 $0 Bronze Silver Gold Platinum SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2023. Data are from Healthcare.gov.
Figure 3 Average Medical Deductible in Plans with Separate Medical and Prescription Drug Deductibles (2023) $3,500 $3,191 $3,000 $2,500 $2,000 $1,462 $1,373 $1,500 $1,000 $500 $355 $0 Bronze Silver Gold Platinum SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2023. Data are from Healthcare.gov.
Figure 4 Distribution of Medical Deductibles Among Bronze Plans, 2022 and 2023 2022 2023 45% 41% 40% 38% 35% 33% 32% 30% 25% 20% 15% 13% 10% 10% 10% 8% 4% 4% 4% 5% 1% 1% 1% 0% $0 $1-$1,500 $1,501-$3,000 $3,001-$4,500 $4,501-$6,000 $6,001-$7,500 $7,501 or more SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2022 and 2023. Data are from Healthcare.gov.
Figure 5 Distribution of Medical Deductibles Among Silver Plans, 2022 and 2023 2022 2023 50% 45% 45% 40% 35% 28% 30% 25% 25% 22% 19% 20% 13% 15% 11% 9% 9% 8% 10% 5% 3% 5% 2% 1% 0% $0 $1-$1,500 $1,501-$3,000 $3,001-$4,500 $4,501-$6,000 $6,001-$7,500 $7,501 or more SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2022 and 2023. Data are from Healthcare.gov.
Figure 6 Distribution of Medical Deductibles Among All Marketplace Plans, 2022 and 2023 2022 2023 25% 21% 21% 20% 20% 17% 17% 16% 15% 15% 13% 13% 12% 10% 9% 9% 10% 8% 5% 0% $0 $1-$1,500 $1,501-$3,000 $3,001-$4,500 $4,501-$6,000 $6,001-$7,500 $7,501 or more SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2022 and 2023. Data are from Healthcare.gov. NOTE: Total may not sum to 100% due to rounding.
Figure 7 Average Medical Deductible in Plans with Combined Medical and Prescription Drug Deductibles (2023) $6,000 $4,890 $5,000 $4,205 $4,000 $3,000 $2,000 $755 $1,000 $97 $0 Silver with no CSR: Incomes over 250% of FPL (over $33,975 for a single individual) Silver, CSR 73% AV: Incomes above 200% up to 250% of FPL (above $27,180 up to $33,975 for a single individual) Silver, CSR 87% AV: Incomes above 150% up to 200% of FPL (above $20,385 up to $27,180 for a single individual) Silver, CSR 94% AV: Incomes 100%-150% of FPL ($13,590-$20,385 for a single individual) SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2023. Data are from Healthcare.gov. NOTE: 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 8 Average Medical Deductible in Plans with Separate Medical and Prescription Drug Deductibles (2023) $3,500 $3,191 $3,000 $2,746 $2,500 $2,000 $1,500 $1,000 $567 $500 $108 $0 Silver with no CSR: Incomes over 250% of FPL (over $33,975 for a single individual) Silver, CSR 73% AV: Incomes above 200% up to 250% of FPL (above $27,180 up to $33,975 for a single individual) Silver, CSR 87% AV: Incomes above 150% up to 200% of FPL (above $20,385 up to $27,180 for a single individual) Silver, CSR 94% AV: Incomes 100%-150% of FPL ($13,590-$20,385 for a single individual) SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2023. Data are from Healthcare.gov. NOTE: 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 9 Average Out-of-Pocket Limit in Plans with Combined Limit for Medical and Prescription Drug Cost Sharing (2023) $9,000 $8,519 $8,000 $6,939 $7,000 $6,000 $5,000 $4,000 $2,747 $3,000 $2,000 $1,321 $1,000 $0 Silver with no CSR: Incomes over 250% of FPL (over $33,975 for a single individual) Silver, CSR 73% AV: Incomes above 200% up to 250% of FPL (above $27,180 up to $33,975 for a single individual) Silver, CSR 87% AV: Incomes above 150% up to 200% of FPL (above $20,385 up to $27,180 for a single individual) Silver, CSR 94% AV: Incomes 100%-150% of FPL ($13,590-$20,385 for a single individual) SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2023. Data are from Healthcare.gov. NOTE: 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.
