Deductibles in ACA Marketplace Plans, 2014-2024

These chart collections provide key data about deductibles and other cost-sharing requirements included in plans sold through the Affordable Care Act (ACA) health insurance marketplaces.  Marketplace plans, like most other private health coverage, require enrollees to pay a portion of the cost when they access health services. Cost-sharing can include deductibles, copayments, and coinsurance, though the deductible is a simple and visible measure of how much an enrollee may be expected to pay for major health services. The deductible is the amount an enrollee must pay toward the cost of in-network covered services before the plan will start paying for most types of care. Some plans have a separate deductible amount for medical care and prescription drugs. Under the Affordable Care Act, private plans are required to pay the full cost of certain in-network preventive services (even before the enrollee has met the deductible amount). Marketplace plans are categorized into “metal levels” based on deductible and other cost-sharing amounts.

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Cost-Sharing for Plans Offered in the Federal Marketplace, 2024 (.ppt)

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Information on plan cost-sharing provisions for the plans offered in federally-facilitated and partnership exchanges was downloaded from Simple averages and distributions of the available plans are shown, and neither are weighted by enrollment. Information for “expanded bronze” and “bronze” plans are reported together. Distinct plans from the landscape file were analyzed to calculate the average deductibles. A distinct plan is defined by having a unique state, issuer, metal level, and cost sharing design combination. In 2014 and 2015, a distinct plan took into consideration the plan marketing name.

The weighted average was calculated using plan selection data at the metal and CSR (or FPL) level from Marketplace Open Enrollment Period Public Use Files. 2023 plan selections were used to weigh 2024 average deductibles. 2015 plan selections were used to weigh 2014 average deductibles. 2017 plan selection data was used to estimate the number of plan selections for silver, no CSR and silver CSR variants in 2015 and 2016.

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