Analysis of Cost Sharing for Plans in 2021 Federal Marketplace
The analysis presents data on the distribution of medical deductibles in plans offered through the Federal Marketplace in 2021. It includes insights on the percentage of plans where medical deductibles are combined or separate from prescription drug deductibles, average medical deductibles in plans with combined and separate deductibles, and the distribution of medical deductibles among Bronze and Silver plans in 2020 and 2021. The figures provide valuable information for understanding cost-sharing trends in healthcare plans.
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Cost-Sharing for Plans Offered in Federal Marketplace for 2021
Figure 1 Percent of Plans Where Medical Deductible is Combined or Separate from the Prescription Drug Deductible (2021) Combined Separate 100% 12% 90% 21% 28% 80% 55% 70% 60% 50% 88% 40% 79% 72% 30% 45% 20% 10% 0% Bronze Silver Gold Platinum SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2021. Data are from Healthcare.gov.
Figure 2 Average Medical Deductible in Plans with Combined Medical and Prescription Drug Deductibles (2021) $8,000 $6,921 $7,000 $6,000 $4,816 $5,000 $4,000 $3,000 $2,000 $1,641 $1,000 $0 $0 Bronze Silver Gold Platinum SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2021. Data are from Healthcare.gov.
Figure 3 Average Medical Deductible in Plans with Separate Medical and Prescription Drug Deductibles (2021) $4,000 $3,529 $3,500 $3,000 $2,500 $2,000 $1,730 $1,648 $1,500 $1,000 $459 $500 $0 Bronze Silver Gold Platinum SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2021. Data are from Healthcare.gov.
Figure 4 Distribution of Medical Deductibles Among Bronze Plans, 2020 and 2021 2021 2020 50% 45% 44% 45% 40% 34% 35% 30% 26% 25% 19% 20% 13% 15% 7% 10% 4% 3% 3% 2% 5% 0% 0% $0 $1,500-$3,000 $3,000-$4,500 $4,500-$6,000 $6,000-$7,500 $7,500 or more SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2021. Data are from Healthcare.gov.
Figure 5 Distribution of Medical Deductibles Among Silver Plans, 2020 and 2021 2021 2020 35% 31% 30% 27% 26% 26% 24% 25% 20% 16% 15% 15% 11% 10% 10% 4% 3% 5% 3% 2% 2% 0% $0 $0-$1,500 $1,500-$3,000 $3,000-$4,500 $4,500-$6,000 $6,000-$7,500 $7,500 or more SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2021. Data are from Healthcare.gov.
Figure 6 Distribution of Medical Deductibles Among All Marketplace Plans, 2020 and 2021 2021 2020 35% 29% 30% 26% 25% 20% 17% 17% 17% 16% 14% 13% 15% 12% 10% 10% 9% 10% 7% 3% 5% 0% $0 $0-$1,500 $1,500-$3,000 $3,000-$4,500 $4,500-$6,000 $6,000-$7,500 $7,500 or more SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2021. Data are from Healthcare.gov.
Figure 7 Average Medical Deductible in Plans with Combined Medical and Prescription Drug Deductibles (2021) $6,000 $4,816 $5,000 $4,000 $3,385 $3,000 $2,000 $800 $1,000 $177 $0 Silver with no CSR: Incomes over 250% of FPL (over $31,900 for a single individual) Silver, CSR 73% AV: Incomes 200%-250% of FPL ($25,550-$31,900 for a single individual) Silver, CSR 87% AV: Incomes 150%-200% of FPL ($19,140-$25,550 for a single individual) Silver, CSR 94% AV: Incomes 100%-150% of FPL ($12,760-$19,140 for a single individual) SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2021. 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 (2021) $4,000 $3,529 $3,500 $2,864 $3,000 $2,500 $2,000 $1,500 $1,000 $666 $500 $149 $0 Silver with no CSR: Incomes over 250% of FPL (over $31,900 for a single individual) Silver, CSR 73% AV: Incomes 200%-250% of FPL ($25,550-$31,900 for a single individual) Silver, CSR 87% AV: Incomes 150%-200% of FPL ($19,140-$25,550 for a single individual) Silver, CSR 94% AV: Incomes 100%-150% of FPL ($12,760-$19,140 for a single individual) SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2021. 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 (2021) $9,000 $8,054 $8,000 $7,000 $6,363 $6,000 $5,000 $4,000 $3,000 $2,528 $2,000 $1,189 $1,000 $0 Silver with no CSR: Incomes over 250% of FPL (over $31,900 for a single individual) Silver, CSR 73% AV: Incomes 200%-250% of FPL ($25,550-$31,900 for a single individual) Silver, CSR 87% AV: Incomes 150%-200% of FPL ($19,140-$25,550 for a single individual) Silver, CSR 94% AV: Incomes 100%-150% of FPL ($12,760-$19,140 for a single individual) SOURCE: KFF analysis of Marketplace plans in states with Federally Facilitated or Partnership exchanges in 2021. 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.
