Financial assistance enables drop in median marketplace deductibles
Decrease is due to 60 percent of consumers qualifying for financial assistance that lowers their deductible, other costs.
Touting the benefits of the Affordable Care Act to cover Americans who otherwise would not have healthcare plans, the Centers for Medicare and Medicaid Services on Tuesday said the median deductible for marketplace coverage in 2016 is $850, down from $900 in 2015.
The decrease is due to 60 percent of consumers qualifying for financial assistance that lowers their deductible, out-of-pocket maximums and other cost-sharing, CMS said.
The nation's uninsured rate, for the first time has fallen below 10 percent, CMS said. An estimated 20 million people have coverage.
About a third of Healthcare.gov enrollees in 2016 have deductibles of $250 or less, when financial assistance is factored in, and more than half have deductibles below $1,000, CMS said.
[Also: Over 40 percent of adults say their deductibles cause undue financial burden, report says]
The majority of marketplace enrollees, 32 percent, have a deductible of $250 or less; 24 percent have a deductible between $250 and $1,000; 17 percent greater than $5,000; 15 percent between $1,001 and $3,000; and 12 percent between $3,000 and $5,000, according to CMS.
Consumers in silver plans who do not qualify for financial assistance have a median deductible of $3,000. For enrollees who do qualify, the deductible is up to $2,500, depending on household income.
More consumers choose silver over bronze plans. The former has lower cost sharing and the latter, the lowest premiums.
[Also: Quarter of adults struggling to cover healthcare costs, high deductibles, Commonwealth Fund says]
On average, the marketplace consumers have seven health services covered before the deductible, CMS said. The services most often include primary care visits, preventative care and coverage for generic drugs.
Median out-of-pockets costs for consumers purchasing individual coverage, taking into account premiums, deductibles and other cost sharing, fell by 25 percent between 2013 and 2014 when the Affordable Care Act took effect, CMS said.
Also, ACA plans have out-of-pocket limits to protect catastrophic costs, CMS said.
[Also: Medicare Part A deductibles rise slightly; No jump in Part B costs for most beneficiaries, CMS says]
An Urban Institute survey shows marketplace consumers have access to care at a rate similar to consumers covered under their employers' plans.
"This report shows that marketplace plans are providing consumers with real financial protections and access to important health services," said Health Insurance Marketplace CEO Kevin Counihan. "As with premiums, marketplace deductibles and out-of-pocket costs in marketplace plans are often lower than advertised thanks to the financial help available. And most plans cover common health services, like primary care visits and generic drugs, with no or low cost-sharing before consumers meet their deductibles."
Twitter: @SusanJMorse
