New York, N.Y., September 25, 2015—Six in 10 marketplace enrollees
and 55 percent of those with employer plans reported they pay either
nothing or less than $125 a month for individual coverage, according to a
new report from The Commonwealth Fund.
According to
Are Marketplace Plans Affordable?,
one of two new briefs based on the Commonwealth Fund Affordable Care
Act (ACA) Tracking Survey, there are similarities between premium costs
for marketplace enrollees and those for people with employer plans.
That’s because most marketplace enrollees are eligible for a premium
subsidy and do not pay the full premium amount out of their own pockets,
similar to how most employers pay part of their employees' premiums.
The effect of subsidies is seen most clearly among people earning less
than 250 percent of the federal poverty level ($29,175 for a single
person), 72 percent of whom paid nothing or less than $125 a month in
premiums.
However, people with employer coverage perceived their health
insurance as more affordable, with 76 percent reporting it was very or
somewhat easy to afford their premiums, compared to 53 percent of those
with marketplace coverage. The difference narrows for those with lower
incomes: 65 percent with employer coverage said it was easy to afford,
compared to 54 percent with marketplace coverage.
Overall, larger shares of adults with marketplace plans had
per-person deductibles of $1,000 or more than did those with employer
plans (43% vs. 34%). The differences were widest among those with higher
incomes: in this group, over half (53%) with marketplace plans had high
deductibles, compared to about one-third (35%) with employer plans. In
the survey, people with high deductibles were less confident than those
with lower deductibles that they could afford needed care.
“The survey findings suggest that the Affordable Care Act’s premium
subsidies have been effective in making the cost of marketplace coverage
similar to that of employer plans for people who have been most at risk
of being uninsured,” said Sara Collins, lead author of the report and
vice president for Health Care Coverage and Access at The Commonwealth
Fund. “But many marketplace enrollees report high deductibles.”
The second study,
To Enroll or Not to Enroll? Why Many Americans Have Gained Insurance Under the Affordable Care Act While Others Have Not,
focused on people’s experience shopping for and enrolling in
marketplace and Medicaid coverage. Two-thirds (66%) of people who bought
new marketplace coverage or switched plans during the 2015 open
enrollment period said costs (premiums, deductibles, and copayments)
were the most important factor in selecting a plan.
Affordability was also a primary reason why some who shopped for
coverage ultimately didn’t enroll—57 percent of those who visited the
marketplaces and didn’t select a plan said they could not find a plan
they could afford. Excluding people who got coverage through another
source, 54 percent of people who said they couldn’t find an affordable
plan had incomes that would have qualified them for subsidies.
One-quarter (26%) of those who said they couldn’t find an affordable
plan lived in a state that had not expanded Medicaid and had incomes
below the range that made them eligible for marketplace subsidies.
Personal Assistance Improves Enrollment Experience
The report found that personal enrollment assistance was helpful to
potential enrollees in both marketplace plans and Medicaid. After
controlling for demographic differences like income and education, 78
percent of marketplace visitors who received personal assistance
eventually enrolled, while only 56 percent of those who did not get
assistance did.
People who enrolled also had an easier time comparing premiums,
out-of-pocket costs, and benefits compared to those who didn’t sign up
for coverage.
“The Affordable Care Act was designed to assure all Americans have
access to affordable and comprehensive health insurance so they can get
the health care they need,” said Commonwealth Fund President David
Blumenthal, M.D. “But this survey shows that problems understanding
insurance offerings are keeping many people from getting insured.”
Having their preferred provider in their plan’s network was of less
concern than were costs to survey respondents when they were selecting a
plan in the marketplace—22 percent of those who chose a plan in 2015
said having their preferred doctor, health clinic, or hospital in their
plan was the most important factor in their decision. Many consumers
were not averse to selecting a plan with a “narrow network” of
providers—54 percent who had the option to pay less for a plan with
fewer participating doctors or hospitals did so.
The authors conclude that the cost of insurance was a significant
reason why millions of people were uninsured prior to the passage of the
ACA and it continues to be a top factor in consumers’ decisions about
whether to sign up for coverage and about which plans they choose. Many
people who ultimately did not enroll expressed concerns about
affordability, even those in the range for subsidies. Others selected
lower-cost plans that may leave them exposed to high deductibles. The
authors suggest that “getting assistance during the enrollment process
may help people better understand the trade-offs between health plans
they were considering. …Whether someone received personal assistance or
not during the enrollment process made a significant difference in
whether they signed up for coverage.”
