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Cost-Sharing Subsidies in Federal Marketplace Plans.

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Presentation on theme: "Cost-Sharing Subsidies in Federal Marketplace Plans."— Presentation transcript:

1 Cost-Sharing Subsidies in Federal Marketplace Plans

2 Medical Deductibles

3 Percent of Plans Where Medical Deductible is Combined With or Separate from Prescription Drug Deductible NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

4 Average Medical Deductible In Plans with Combined Medical and Prescription Drug Deductible NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

5 Average Medical Deductible In Plans with Separate Medical and Prescription Drug Deductibles NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

6 Drug Deductibles

7 Average Prescription Drug Deductible In Plans with Separate Medical and Prescription Drug Deductible NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

8 Out-of-Pocket Limits

9 Average Out-Of-Pocket Limit In Plans with Combined Limit for Medical and Prescription Drug Cost Sharing NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

10 Inpatient Facility Cost Sharing

11 Share of Plans by Type of Inpatient Facility Cost Sharing NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

12 Average Copayments for Inpatient Facility Services (includes plans with both copayments and coinsurance) NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

13 Average Inpatient Facility Coinsurance Rate (includes plans with both coinsurance and copayments) NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

14 Inpatient Physician Services

15 Share of Plans by Type of Cost Sharing for Inpatient Physician Services NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

16 Average Copayments for Inpatient Physician Services NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

17 Average Coinsurance Rate For Inpatient Physician Services (includes plans with both coinsurance and copayments) NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

18 Primary and Specialist Physician Cost Sharing

19 Share of Plans by Type of Cost Sharing for Primary Care Physician Visits (deductible may apply first) NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

20 Average Copayments for Primary Care Physician Visits NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

21 Average Coinsurance Rates for Primary Care Physician Visits NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

22 Share of Plans by Type of Cost Sharing for Specialist Physician Visits (deductible may apply first) NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

23 Average Copayments for Specialist Physician Visits NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

24 Average Coinsurance Rates for Specialist Physician Visits NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

25 Prescription Drugs

26 Share of Plans by Type of Cost Sharing for Generic Prescription Plans with Combined Medical and Prescription Drug Deductible NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

27 Share of Plans by Type of Cost Sharing for Generic Prescription Plans with Separate Medical and Prescription Drug Deductible NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

28 Average Copayment for Generic Drugs NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

29 Average Coinsurance Rates for Generic Drugs NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

30 Share of Plans by Type of Cost Sharing for Preferred Prescriptions Plans with Combined Medical and Prescription Drug Deductible NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

31 Share of Plans by Type of Cost Sharing for Preferred Prescriptions Plans with Separate Medical and Prescription Drug Deductible NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

32 Average Copayment for Preferred Drugs NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

33 Average Coinsurance Rates for Preferred Drugs NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

34 Share of Plans by Type of Cost Sharing for Non-Preferred Prescriptions Plans with Combined Medical and Prescription Drug Deductible NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

35 Share of Plans by Type of Cost Sharing for Non-Preferred Prescriptions Plans with Separate Medical and Prescription Drug Deductible NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

36 Average Copayment for Non-Preferred Drugs NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

37 Average Coinsurance Rates for Non-Preferred Drugs NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

38 Share of Plans by Type of Cost Sharing for Specialty Prescriptions Plans with Combined Medical and Prescription Drug Deductible NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

39 Share of Plans by Type of Cost Sharing for Specialty Prescriptions Plans with Separate Medical and Prescription Drug Deductible NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

40 Average Copayment for Specialty Drugs NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

41 Average Coinsurance Rates for Specialty Drugs NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

42 Emergency Room Cost Sharing

43 Share of Plans by Type of Emergency Room Cost Sharing NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

44 Average Emergency Room Copayments (includes plans with both copayments and coinsurance) NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/

45 Average Emergency Room Coinsurance Rate (includes plans with both coinsurance and copayments) NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/https://www.healthcare.gov/health-plan-information/


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