Cost-Sharing for Plans Offered in the Federal Marketplace, 2014-2022
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.
Information on plan cost-sharing provisions was downloaded from HealthCare.gov for the plans offered in federally-facilitated and partnership exchanges. Each plan benefit package was counted only once for each state. The averages and distributions are simple averages of the plans that are available and are not weighted by enrollment. Information for “expanded bronze” and “bronze” plans are reported together.