Dive Brief:
- A CMS data brief released Tuesday argued that other ACA cost-sharing analyses have failed to factor in the subsidies that many people receive to bring down their deductibles and copayments based on their income.
- Ignoring this financial assistance "gives a misleading picture of what consumers actually pay," the brief argued.
- While CMS touted that the median individual deductible for marketplace policies in 2016 is $850, which is actually down from $900 in 2015, others have pointed away from the median and toward those ACA consumers with middle to higher incomes as proof of high ACA plan costs. This year, 43% of ACA plan enrollees have an average deductible of at least $2,500, Modern Healthcare noted.
Dive Insight:
CMS' defensive stance on ACA plan cost-sharing focused on two main points: Subsidies for which 60% of 2016's HealthCare.gov consumers qualified, and that ACA plans cover numerous healthcare services with "no or low cost-sharing" without consumers needing to meet their deductibles.
According to a late 2015 Kaiser Family Foundation analysis that did not account for financial assistance, the average deductible for a mid-level ACA plan was $3,064. CMS' new brief stated, "Just as examining marketplace premiums without accounting for advance payment of premium tax credits gives a highly misleading picture of what consumers actually pay, examining cost sharing without taking into account cost-sharing reductions substantially exaggerates consumers’ actual deductibles."
As for covered services, CMS highlighted that marketplace policies on average cover seven of the most common and needed healthcare services such as generic drugs, primary care visits, and preventive services.
"This means that even accurately-measured deductibles present an incomplete picture of consumers’ actual cost-sharing obligations, since deductibles do not apply to most consumers’ most frequent health care needs," CMS noted.