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New Analysis Finds Marketplace Plans with Lowest Premiums Are Often Not the Most Cost-Effective Option for People with HIV

Among 300 Enrollment Options Examined, an HIV Positive Enrollee Could Save $4,000 on Average by Assessing a Fuller Range of Costs

A new Kaiser Family Foundation analysis finds that people living with HIV could benefit from looking beyond premium costs when shopping for a health plan in the marketplace – as plans with the lowest premiums are often not the most cost-effective option. People with HIV can find lower cost plans by conducting a more comprehensive cost assessment that includes other factors such as deductibles, drug costs, and out-of-pocket maximums.

The analysis explores 300 possible enrollment scenarios for five plans in five states that together account for about 50 percent of the national HIV epidemic. It provides estimates of the costs HIV positive consumers might expect to face when enrolling in a Marketplace plan. Among the options assessed, it finds that an HIV positive enrollee could save, on average, about $4,000 by taking into account a fuller range of costs. For enrollees with incomes low enough to qualify for the most generous cost-sharing subsidies, silver plans provided the lowest expected costs, but for enrollees with higher incomes, the metal level plan providing the lowest cost was highly variable across markets.

In addition, the analysis finds those with the lowest incomes paid a greater share of their income toward health care than did those with the highest income and highlighted the important role the Ryan White HIV/AIDS Program plays in moderating costs for consumers.

The Foundation also released a new series of short videos featuring people with HIV sharing their experiences with health coverage in the ACA era, including those living in the “coverage gap” as well as those who have gained insurance coverage. The videos highlight the role the Ryan White HIV/AIDS Program continues to play in the lives of people with HIV.

The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.