Transcript Inpatient Cost Sharing - Kaiser Family Foundation

Cost-Sharing for Plans Offered in Federally
Facilitated or Partnership Marketplaces for
2015
Medical and Prescription Drug Deductibles
Percent of Plans Where Medical Deductible is Combined with or
Separate from the Prescription Drug Deductible
100%
9%
90%
80%
45%
70%
63%
62%
60%
Separate
50%
91%
Combined
40%
30%
55%
20%
37%
38%
Gold
Platinum
10%
0%
Bronze
Silver
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Medical Deductible, in Plans with Combined Medical and
Prescription Drug Deductibles
$6,000
$5,328
$5,000
$4,000
$3,000
$2,556
$2,000
$845
$1,000
$69
$0
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Medical Deductibles, for all Plans with
Combined Medical and Prescription Drug Deductible
Bronze
Silver
Gold
Platinum
120%
96%
100%
80%
60%
47%
45%
42%
41%
38%
40%
20%
5%
11%
9%
4%
39%
11%
6%
2%
0%
$500 or less
>$500 - $1500
>1500-$2500
>2500-$4000
>4000-$5500
Over $5500
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Medical Deductibles, for Bronze Plans with
Combined Medical and Prescription Drug Deductible
40%
34%
35%
30%
30%
25%
22%
20%
15%
11%
10%
5%
2%
0%
0%
$2000 or less
>$2000 -$2500
>$2500 - $4000
>$4000 - $5000
>$5000 - $6000
Over $6000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Medical Deductibles, for Silver Plans with
Combined Medical and Prescription Drug Deductibles
45%
41%
40%
38%
35%
30%
25%
20%
15%
9%
10%
5%
7%
4%
0%
$0
>0 - $1500
>$1500 -$2500
>$2500 - $4000
Over $4000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Medical Deductibles, for Gold Plans with
Combined Medical and Prescription Drug Deductibles
30%
27%
25%
25%
20%
20%
15%
15%
10%
8%
5%
5%
0%
$0
>0 - $500
>$500-$1000
>$1000 - $1500
>$1500 - $2000
Over $2000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Medical Deductibles for Platinum Plans with
Combined Medical and Prescription Drug Deductibles
90%
84%
80%
70%
60%
50%
40%
30%
20%
13%
10%
4%
0%
$0
>0 - $500
Over $500
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Medical Deductible In Plans with Separate Medical and
Prescription Drug Deductibles
$6,000
$5,372
$5,000
$4,000
$3,453
$3,000
$2,000
$1,431
$1,000
$418
$0
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Medical Deductibles, for all Plans with Separate
Medical and Prescription Drug Deductible
Bronze
0.8
Silver
71%
Gold
0.7
Platinum
58%
0.6
48%
0.5
43%
42%
0.4
29%
0.3
24%
20%
17%
0.2
14%
10%
0.1
2%
4%
8%
6%
2%
0
$500 or less
>$500 - $1500
>1500-$2500
>2500-$4000
>4000-$5500
Over $5500
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Medical Deductibles, for Bronze Plans with
Separate Medical and Prescription Drug Deductibles
45%
40%
40%
35%
31%
30%
25%
19%
20%
15%
10%
6%
5%
2%
0%
$2500 or less
>$2500 -$4000
>4000 - $5000
>$5000 - $6000
Over $6000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Medical Deductibles, for Silver Plans with
Separate Medical and Prescription Drug Deductibles
35%
31%
30%
24%
25%
19%
20%
15%
15%
9%
10%
5%
2%
0%
$0
>$0 - $2000
$>2000 -$3000
>$3000 - $4000
>$4000 - $5000
Over $5000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Medical Deductibles, for Gold Plans with
Separate Medical and Prescription Drug Deductibles
35%
31%
30%
26%
25%
20%
18%
14%
15%
10%
7%
5%
3%
0%
$0
>$0 - $500
>$500-$1000
>$1000 - $1500
>$1500 - $2000
Over $2000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Medical Deductibles, for Platinum Plans with
Separate Medical and Prescription Drug Deductibles
45%
41%
40%
35%
30%
30%
29%
25%
20%
15%
10%
5%
0%
$0
>$0 - $500
Over $500
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Separate Drug Deductibles
Average Prescription Drug Deductible, for Plans with Separate
Medical and Prescription Drug Deductible
$500
$465
$450
$400
$335
$350
$300
$250
$200
$150
$139
$133
Gold
Platinum
$100
$50
$0
Bronze
Silver
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Prescription Drug Deductibles, for Bronze Plans with
Separate Medical and Prescription Drug Deductibles
60%
52%
50%
40%
30%
19%
20%
15%
10%
10%
2%
0%
$0
>$0 - $250
>$250 - $500
>$500 - $1000
Over $1000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Prescription Drug Deductibles, for Silver Plans with
Separate Medical and Prescription Drug Deductibles
60%
54%
50%
40%
30%
20%
17%
15%
8%
10%
7%
0%
$0
>$0 - $250
>$250 - $500
>$500 - $1000
Over $1000
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Prescription Drug Deductibles, for Gold Plans with
Separate Medical and Prescription Drug Deductibles
70%
61%
60%
50%
40%
30%
20%
20%
19%
10%
0%
0%
$0
>$0 - $250
>$250 - $500
Over $500
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Prescription Drug Deductibles, for Platinum Plans
with Separate Medical and Prescription Drug Deductibles
80%
70%
69%
60%
50%
40%
30%
22%
20%
8%
10%
1%
0%
$0
>$0 - $250
>$250 - $500
Over $500
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Inpatient Facility Cost Sharing
Share of Plans by Type of Inpatient Facility Cost Sharing
100%
4%
90%
1%
12%
9%
80%
70%
Copay & Coinsurance
52%
60%
Coinsurance
61%
68%
79%
No Charge after Deductible
50%
40%
Copayment
No Charge
9%
30%
20%
13%
35%
10%
14%
15%
8%
0%
Bronze
Silver
Gold
12%
4%
4%
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Inpatient Facility Average Copayments (includes plans with both
copayments and coinsurance)
$1,000
$936
Per Day
$900
$800
Per Stay
$780
$700
$600
$511
$500
$502
$456
$400
$323
$321
$269
$300
$200
$100
$0
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Inpatient Facility Copayments
100%
90%
13%
2%
2%
2%
17%
5%
2%
1%
16%
2%
3%
0%
0%
Over $1000
29%
17%
80%
70%
33%
44%
19%
29%
>$750 - $1000
>$500 - $750
52%
46%
>$250 - $500
$250 or less
60%
50%
15%
20%
47%
40%
77%
71%
30%
49%
20%
27%
34%
10%
0%
48%
46%
19%
7%
Bronze per
day
6%
Bronze per Silver per day Silver per stay Gold per day Gold per stay Platinum per Platinum per
stay
day
stay
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Inpatient Facility Coinsurance Rate
35%
32%
30%
28%
25%
20%
20%
20%
Gold
Platinum
15%
10%
5%
0%
Bronze
Silver
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Inpatient Facility Coinsurance Rates
100%
1%
90%
18%
1%
1%
3%
12%
Over 50%
8%
>40%-50%
80%
70%
>30% - 40%
>20% - 30%
25%
20% or less
60%
74%
84%
50%
73%
40%
30%
52%
20%
23%
10%
0%
15%
5%
7%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Inpatient Physicians Cost Sharing
Share of Plans by Type of Cost Sharing for Inpatient Physicians Cost
Sharing
100%
90%
Coinsurance
80%
70%
Copayment
57%
No Charge after Deductible
75%
60%
80%
79%
1%
5%
No Charage
50%
40%
30%
20%
41%
21%
10%
0%
14%
16%
1%
3%
5%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates For Inpatient Physician Services
35%
32%
30%
28%
25%
20%
20%
21%
15%
10%
5%
0%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Inpatient Physician Coinsurance Rates
100%
1%
1%
1%
3%
82%
77%
12%
90%
18%
8%
80%
70%
25%
60%
>40%-50%
50%
>30% - 40%
74%
>20% - 30%
40%
30%
20% or less
50%
20%
10%
0%
Over 50%
17%
7%
7%
Bronze
Silver
Gold
21%
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Specialist and Primary Care Physician Office
Visits
Share of Plans by Type of Cost Sharing for Primary Care Physician
Visits (deductible may apply first)
100%
6%
13%
90%
80%
3%
2%
6%
10%
Copay & Coinsurance
24%
Coinsurance
70%
Copayment
60%
50%
No Charge after Deductible
No Charage
39%
73%
83%
92%
1%
4%
2%
1%
Silver
Gold
40%
30%
20%
32%
10%
10%
0%
Bronze
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Copayments for Primary Care Physician Visits
$40
$37
$35
$30
$28
$25
$22
$19
$20
$15
$10
$5
$0
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Copayments for Primary Care Physician Visits
100%
1%
10%
10%
3%
4%
1%
1%
Over $50
90%
80%
14%
>$40 - $50
12%
47%
45%
70%
>$30 - $40
>$20 - $30
>$10 - $20
60%
40%
$10 or less
50%
50%
40%
26%
28%
30%
18%
12%
20%
10%
17%
0%
1%
Bronze
15%
Silver
20%
Gold
25%
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Primary Care Physician Visits
35%
33%
30%
26%
25%
21%
21%
Gold
Platinum
20%
15%
10%
5%
0%
Bronze
Silver
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Primary Care Physician Visits
100%
90%
1%
12%
5%
2%
5%
13%
18%
16%
Over 50%
80%
16%
70%
32%
>30% - 40%
30%
>20% - 30%
60%
56%
50%
40%
>40% - 50%
26%
>10% - 20%
10% or less
17%
36%
30%
20%
10%
0%
42%
26%
17%
24%
5%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Specialist Physician Visits
(deductible may apply first)
100%
3%
90%
80%
2%
18%
2%
8%
13%
Copay & Coinsurance
30%
Coinsurance
70%
Copayment
60%
50%
No Charge after Deductible
33%
70%
81%
91%
40%
30%
20%
34%
10%
11%
0%
Bronze
Silver
4%
1%
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Copayments for Specialist Physician Visits
$70
$65
$60
$56
$50
$44
$40
$29
$30
$20
$10
$0
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Copayments for Specialist Physician Visits
100%
5%
2%
5%
16%
90%
Over $100
20%
80%
>$75 - $100
45%
70%
60%
48%
>$50 - $75
>$25 - $50
34%
>$10 - $25
50%
$10 or less
71%
40%
30%
47%
47%
20%
40%
10%
13%
0%
1%
2%
Bronze
Silver
3%
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Specialist Physician Visits
40%
35%
34%
30%
26%
25%
20%
19%
19%
Gold
Platinum
15%
10%
5%
0%
Bronze
Silver
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Specialist Physician Visits
100%
1%
90%
20%
14%
13%
11%
0%
Over 50%
13%
>40% - 50%
6%
80%
0%
4%
2%
>30% - 40%
70%
60%
31%
31%
22%
>10% - 20%
56%
10% or less
50%
40%
>20% - 30%
18%
34%
30%
52%
20%
25%
28%
10%
0%
16%
5%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Prescription Drug Cost Sharing
Share of Plans by Type of Cost Sharing for Generic Prescriptions
Plans with Combined Medical and Prescription Drug Deductible
100%
12%
90%
18%
22%
28%
80%
Copayment & Coinsurance
Coinsurance
Copayment
70%
38%
28%
No Charge after Deductible
25%
60%
34%
50%
40%
21%
46%
30%
48%
20%
10%
5%
0%
Bronze
Silver
Gold
1%
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Generic Prescriptions
Plans with Separate Medical and Prescription Drug Deductible
100%
2%
1%
1%
1%
90%
Coinsurance
Copayment
80%
No Charge
70%
60%
50%
82%
78%
97%
98%
40%
30%
20%
10%
17%
20%
2%
0%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Copayment for Generic Drugs
$20
$19
$18
$16
$14
$13
$12
$10
$10
$8
$8
$6
$4
$2
$0
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Copayment Amounts for Generic Drugs
100%
11%
90%
1%
3%
0%
6%
1%
15%
24%
80%
25%
70%
60%
50%
26%
>$15 - $20
>$10 - $15
55%
>$5 = $10
22%
$5 or less
34%
20%
33%
10%
0%
Over $25
>$20 - $25
40%
30%
67%
37%
11%
5%
Bronze
11%
Silver
15%
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Generic Drugs
35%
30%
30%
29%
26%
25%
23%
20%
15%
10%
5%
0%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Generic Drugs
100%
90%
15%
24%
25%
5%
80%
70%
7%
20%
0%
4%
23%
20%
60%
40% or more
50%
50%
37%
20%
>20% - 30%
>10% - 20%
40%
34%
10% or less
30%
20%
>30% - >50%
10%
19%
38%
10%
13%
20%
17%
0%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Preferred Prescriptions
Plans with Combined Medical and Prescription Drug Deductible
100%
9%
90%
80%
26%
23%
38%
70%
60%
50%
Coinsurance
26%
58%
40%
69%
91%
Copayment
No Charge after Deductible
30%
20%
36%
10%
17%
8%
0%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Preferred Prescriptions
Plans with Separate Medical and Prescription Drug Deductible
100%
90%
6%
7%
94%
93%
Silver
Gold
1%
19%
80%
70%
60%
50%
40%
99%
Coinsurance
Copayment
81%
30%
20%
10%
0%
Bronze
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Copayment for Preferred Drugs
$70
$63
$60
$50
$47
$40
$37
$28
$30
$20
$10
$-
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Copayment Amounts for Preferred Drugs
100%
3%
9%
90%
80%
2%
4%
13%
4%
13%
39%
70%
60%
Over $60
6%
58%
48%
57%
>$40 - $50
50%
>$30 - $40
40%
30%
>$20 - $30
47%
20%
20% or less
24%
27%
25%
10%
0%
>$50 - $60
6%
2%
5%
7%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Preferred Drugs
33%
32%
32%
31%
30%
30%
29%
28%
27%
27%
27%
Gold
Platinum
26%
25%
24%
Bronze
Silver
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Preferred Drugs
100%
11%
90%
27%
18%
22%
8%
80%
70%
11%
11%
60%
40% or more
52%
50%
64%
39%
36%
>30% - >40%
>20% - 30%
>10% - 20%
40%
10% or less
30%
12%
20%
19%
24%
10%
17%
18%
Gold
Platinum
10%
0%
2%
Bronze
Silver
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Non-Preferred Prescriptions
Plans with Combined Medical and Prescription Drug Deductible
100%
11%
90%
80%
44%
40%
Coinsurance
40%
70%
Copayment
60%
No Charge after Deductible
50%
88%
20%
40%
40%
52%
30%
20%
36%
10%
20%
8%
0%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Non-Preferred Prescriptions
Plans with Separate Medical and Prescription Drug Deductible
100%
90%
80%
25%
22%
31%
44%
Coinsurance
70%
Copayment
60%
50%
40%
30%
75%
78%
Silver
Gold
69%
56%
20%
10%
0%
Bronze
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Copayment for Non-Preferred Drugs
$120
$106
$100
$85
$80
$74
$60
$55
$40
$20
$0
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Copayment Amounts for Non-Preferred Drugs
100%
8%
1%
9%
2%
2%
4%
90%
22%
80%
27%
35%
>$100 - $150
39%
70%
Over $150
>$75 - $100
60%
50%
>$50 - $75
$50 or less
30%
66%
40%
30%
20%
60%
47%
34%
10%
0%
1%
4%
Bronze
Silver
8%
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Non-Preferred Drugs
38%
37%
37%
37%
36%
35%
34%
34%
33%
33%
32%
31%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Non-Preferred Drugs
100%
90%
>30% - <50%
80%
51%
70%
56%
>20% - 30%
58%
71%
>10% - 20%
60%
10% or less
50%
40%
29%
15%
10%
30%
20%
10%
0%
19%
16%
13%
10%
22%
17%
2%
Bronze
6%
Silver
3%
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Specialty Prescriptions
Plans with Combined Medical and Prescription Drug Deductible
100%
1%
1%
90%
80%
70%
Copayment and Coinsurance
61%
68%
60%
Coinsurance
82%
98%
50%
40%
Copayment
No Charge after Deductible
3%
30%
9%
20%
36%
22%
10%
8%
10%
0%
Bronze
Silver
Gold
1%
1%
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Specialty Prescriptions
Plans with Separate Medical and Prescription Drug Deductible
100%
90%
80%
70%
67%
65%
67%
Coinsurance
60%
88%
Copayment
50%
40%
30%
20%
33%
34%
33%
Silver
Gold
Platinum
10%
12%
0%
Bronze
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Copayment for Specialty Drugs
$200
$180
$174
$179
$160
$160
$139
$140
$120
$100
$80
$60
$40
$20
$0
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Copayment Amounts for Specialty Drugs
100%
8%
8%
90%
8%
5%
12%
8%
2%
14%
80%
13%
28%
70%
23%
60%
Over $250
39%
23%
50%
58%
25%
$100 or less
47%
20%
10%
>$150 - $200
>$100 - $150
40%
30%
>$200 - $250
39%
16%
15%
8%
0%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Specialty Drugs
40%
36%
36%
35%
30%
30%
28%
25%
20%
15%
10%
5%
0%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Specialty Drugs
100%
90%
30%
29%
80%
70%
56%
56%
60%
>30% - <50%
50%
45%
>20% - 30%
52%
40%
30%
>10% - 20%
10% or less
27%
23%
20%
19%
17%
11%
10%
15%
2%
4%
7%
8%
0%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Emergency Room Cost Sharing
Share of Plans by Type of Emergency Room Cost Sharing
100%
12%
90%
18%
22%
28%
80%
70%
38%
28%
Copay & Coinsurance
Coinsurance
25%
60%
34%
Copayment
50%
40%
No Charge after
Deductible
21%
46%
30%
48%
20%
37%
29%
10%
0%
Bronze
8%
5%
1%
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Emergency Room Copayments
(Includes plans with both copayments and coinsurance)
$350
$318
$300
$264
$252
$250
$200
$155
$150
$100
$50
$0
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Emergency Room Coinsurance Rate
(Includes plans with both coinsurance and copayments)
35%
32%
30%
28%
25%
22%
20%
20%
15%
10%
5%
0%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Out-of-Pocket Maximums
Average Out-Of-Pocket Limit In Plans with Combined Limit for
Medical and Prescription Drug Cost Sharing
$7,000
$6,359
$5,826
$6,000
$5,000
$4,529
$4,000
$3,000
$1,975
$2,000
$1,000
$0
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Out-Of-Pocket Limits In Plans with Combined Limit for
Medical and Prescription Drug Cost Sharing
100%
5%
90%
28%
1%
7%
1%
22%
80%
40%
70%
60%
$6,600
>$4,500 to < $6,600
50%
62%
91%
40%
>$2,500 to $4,500
>$500 to $2,500
72%
47%
30%
20%
10%
15%
8%
0%
Bronze
Silver
Gold
Platinum
SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/