Marketplace Consumers Gaining Financial Protections

By Carolyn McCoy

Results from our 2016 consumer survey show that concerns about affordability remain the primary reason consumers have not enrolled in health insurance through the marketplace. The best way to combat this perception is to ensure consumers are aware of the financial help available to help purchase marketplace plans. A new report sheds light on the financial protections marketplace enrollees are receiving.

Last month, the Centers for Medicare & Medicaid Services (CMS) released a new analysis on coverage and cost sharing protections consumers are getting through HealthCare.gov for the 2016 coverage year. Despite news coverage that often focuses on rising out-of-pocket costs, the report includes some positive info on out-of-pocket costs for HealthCare.gov enrollees in 2016, including:

  • The median individual deductible ($850) is down $50 from 2015
  • One-third of marketplace enrollees have deductibles less than or equal to $250
  • Over half have deductibles below $1,000

The analysis also reinforces the importance of continuing to promote the many services that consumers can access with their health insurance that are covered without any cost sharing. All plans must cover preventive services before the deductible and without cost sharing, but more than half of plans cover at least six additional services, like generic drugs, primary care, and other provider visits before the deductible. This is encouraging, since it means marketplace plans are doing more than just offering affordable premiums; they are also enabling consumers to access more affordable care, and consumers who use their coverage are more likely to retain coverage over time.

Finally, according to the report, consumers are taking advantage of the opportunity to shop and compare plans — oftentimes choosing a silver plan over a bronze plan, even though the monthly premiums are more expensive, since they are offered more generous cost sharing protections.

As we head into the next open enrollment period, talking about affordability will be more important than ever before in order to attract the remaining uninsured to enroll. This report paints a picture of marketplace coverage that is affordable thanks not only to financial help that lowers premiums, but also to cost sharing reductions and plan designs that make it affordable to get care once consumers are enrolled.

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