New Reports on Health Care Affordability, Cost Sharing, and Plan Shopping Are Released

Reports released this week by the Commonwealth Fund and the Kaiser Family Foundation (KFF) show that cost sharing continues to be a challenge for some populations, while a second KFF report indicates shopping for Marketplace plans may help to alleviate these concerns. The Commonwealth Fund's Health Care Affordability Index found that 25% of privately insured people of working age (who are mainly covered by employer plans) have high healthcare cost burdens relative to their income, and that two in five adults whose healthcare deductibles are 5% or more of their income did not seek recommended care because of the deductible. A KFF brief explored the role of cost sharing, including deductibles, in 2016 HealthCare.gov plans. That study found that cost sharing varies "quite a bit" from plan to plan, and that the average combined deductible for 2016 silver plans increased 20% to $3,064 between 2015 and 2016, though the authors note that the increase is likely offset by a decrease in other forms of cost sharing. Additionally, a separate KFF study found that most HealthCare.gov consumers will pay 15% higher premiums on average (before tax credits) if they remain in their 2015 plan for 2016, and that in nearly three-quarters of the counties in HealthCare.gov states, the lowest-priced silver plan for 2016 is a different plan than the lowest-priced silver plan for 2015.

Study Finds Low Take-Up Rates during Special Enrollment Periods

Fewer than 15% of uninsured consumers eligible to enroll in Marketplace coverage during special enrollment periods (SEPs) do so, according to a new report by the Urban Institute and Robert Wood Johnson Foundation. The report estimates that 46.5 million Americans will be eligible for a SEP in 2016, including 33.5 million individuals who will need SEPs to prevent coverage gaps and losses. The authors estimate that 1.7 million individuals enrolled during a SEP in 2015, representing 5% of the total number of individuals who require a SEP to avoid a short- or longer-term coverage gap. The report recommends Marketplaces conduct specific outreach and enrollment strategies targeted to job-loss and Medicaid termination, the two most widely applicable SEPs.