ACA: Looking Beyond Technical Glitches

A Preliminary Analysis of Premiums and Cost Sharing in the New Health Insurance Marketplaces

Open enrollment for the Affordable Care Act's (ACA) insurance exchanges began this fall, however, systematic problems with healthcare.gov, the website for federally-facilitated exchanges, have largely overshadowed any discussion of the new plans. Experts are compiling data on plans offered through the exchanges--including cost-sharing data like deductibles, out-of-pocket limits, and copayment and coinsurance amounts for specific services.

This report provides an look at what young adults will pay out-of-pocket for insurance plans on the new health insurance exchanges. The report shows a snapshot of premiums, deductibles, copayments and coinsurance amounts for primary care physician (PCP) and specialist vistis for silver-level plans in 96 rating areas across 15 state marketplaces.

Key Findings

• Almost half of those predicted to buy insurance on the exchange will be eligible for tax credits that would reduce their premiums.  
• Premiums alone do not give a complete picture of potential out-of-pocket health costs that consumers may face; for that picture consumers will also need to consider cost-sharing.

This series, prepared by Breakaway Policy Strategies with funding from the Robert Wood Johnson Foundation, will review all of the plans being offered in all 50 state marketplaces that goes well beyond an examination of premiums.