Analysis: Consumer Deductibles Vary Significantly Across Exchange Plans

NEWS RELEASE: An analysis by Avalere Health finds that consumers who enroll in exchange plans will, on average, face dramatically different deductibles based on the metallic level plan (i.e., bronze, silver, gold, platinum).

As a result, consumers may incur large variations in their out-of-pocket costs before health plan coverage begins.  Avalere analyzed 603 health plans in both federally-facilitated and state-based exchanges across all metallic levels and found that the  average silver plan deductible for a single individual was $2,567.  In addition, Avalere found significant changes in deductibles when moving from a less generous plan to a more generous plan (e.g., from silver to gold) and vice-versa (e.g., from silver to bronze).

“Consumers need to look at the whole package, not just premiums, to make an informed decision about the right plan,” said Caroline Pearson, vice president at Avalere.  “Some consumers with greater healthcare needs might be better off buying a more generous plan with higher monthly premium and lower deductibles.  Depending on their situation, others might do better to trade higher deductibles in a silver or bronze plan for lower premiums,” said Pearson.

For example, a consumer who “buys up” from a silver to a gold would, on average, see their deductible drop by nearly two-thirds (64%) from $2,567 to $932 (a difference of $1,635).  By contrast, an individual who enrolls in a less generous bronze plan  instead of a silver plan would typically face an increase of nearly 70% in their deductible, as it would rise to $4,343.

It is important to note that, under the Affordable Care Act, certain preventive treatments and services, such as flu shots and annual physicals, have first dollar coverage and are not subject to an annual deductible.  In addition, some health plans have  prescription drug formularies that exempt some cost sharing tiers -- such as those for common generic drugs -- from deductibles.

Download the PDF below to see the average medical deductibles by metal level.

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