ACA’s Cost-Sharing Reductions Sharply Lower Payments for Enrollees, but Out-of-Pocket Costs Vary

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<p>The Affordable Care Act’s cost-sharing reductions, available to low-to-moderate-income people in silver-tier marketplace plans, substantially lower deductibles, out-of-pocket spending limits, and copayments for a range of key health services, a new <a href="/publications/issue-briefs/2016/mar/how-will-affordable-care-acts-cost-sharing-reductions-affect" target="_blank">Commonwealth Fund brief</a> finds. But because the amount they are reduced by depends on the way individual plans are designed, consumers’ out-of-pocket spending will vary from plan to plan.</p><p>The study, conducted by Sara R. Collins, Munira Gunja, and Sophie Beutel, looked at health plans available in the largest markets in states using the federal marketplace. The researchers found that cost-sharing reductions lower deductibles by thousands of dollars for those qualifying, and they are projected to substantially reduce out-of-pocket spending—especially for high users of health care.</p>
<p>A <a href="/publications/issue-briefs/2016/mar/how-deductible-exclusions-marketplace-plans-improve-access-many" target="_blank">companion analysis</a> determined that 30 of 37 silver-tier plans studied that have deductibles exclude primary care visits and generic drugs from them, and a majority also exclude specialist visits, prescriptions for preferred drugs, and outpatient mental health. Many insurers will cover certain services without enrollees needing to first meet the plan deductible; instead only a copayment or coinsurance is required. </p> Read the briefs