Affordable Care Act Plans Could Be Less Expensive Than Previously Thought

Not accounting for certain aspects could lead to a misleading picture of how costly ACA plans are.

The US Centers for Medicare and Medicaid Services (CMS) recently released a report that could potentially put to rest the perception that Affordable Care Act (ACA) marketplace plans are expensive and unaffordable.

The CMS discovered that more than 11.1 million individuals are covered through the ACA, and the uninsured rate in 2016 is less than 10%. CMS reports that the median individual deductible is $850, while in 2015, the average deductible was $900.

CMS also said that 60% of individuals qualify for federal subsidies that lower these premiums. Calculating deductibles without considering subsidies can present a misleading figure.

Additionally, all plans currently have out-of-pocket limits in order to reduce high costs. The healthcare.gov website also offers tools that assist individuals in choosing tradeoffs between costs and increased coverage.

Taking subsidies and choices into account, the CMS reported that one-third of enrollees have deductibles less than or equal to $250. These plans also cover an average of 7 services prior to meeting their deductibles, which are provided along with preventative services.

Since deductibles do not apply to preventative services, even the most accurately-calculated deductibles can be misleading, according to the CMS.

“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 in a press release. “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.”