Dive Brief:
- A recent analysis by Avalere Health finds that more than 2 million people enrolled in plans through health insurance exchanges are missing out on subsidies that could significantly reduce their out-of-pocket costs.
- Those at a certain income level (100 to 250% of the federal poverty level) qualify for cost-sharing reductions, but only if they purchase a silver-level plan. Cost-sharing reductions are separate from the premium tax credits (for those with incomes up to 400% of the poverty level) that are applicable to any level of plan.
- Avalere's analysis determined that 8.1 million people had incomes that qualified them for cost-sharing reductions, but that only 5.9 million received them.
Dive Insight:
Given that the reductions are automatically applied to qualified people enrolling in silver-level plans, some of those who didn't receive them probably enrolled in the less expensive bronze-level plans, according to Elizabeth Carpenter, a vice president at Avalere.
That choice to forgo the reductions for a cheaper plan may not actually save enrollees money.
“Surveys show that people shop for plans based on premiums,” Carpenter is quoted by Kaiser Health News. “But if somebody forgoes cost-sharing reductions in order to pay a lower monthly premium and then has an unexpected accident or illness, their out-of-pocket exposure is likely to be higher.”
Enrollees with a silver plan are responsible for paying 30% of their out-of-pocket cost medical costs, but the cost-sharing reduction can lower that to as little as 6%, depending on income, and lower the individual's maximum out-of-pocket spending limit.